Registration Form – Southside

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Fill out the form below. Once we receive your form, you will be contacted by one of our teachers to set up your lessons.

Student Name *

Mailing Address *

City *

State * VirginiaNorth CarolinaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontWashingtonWest VirginiaWisconsinWyoming

ZIP *

Home Phone *

Is student a minor child (under 18)? *

Yes

No

Birthdate *

Current School *

Current Grade *

Preferred Instrument of Study *

Previous Music Experience

Are you registering a second student for lessons? *

Yes

No

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Student Name *

Is student a minor child? (Under 18) *

Yes

No

Birthdate *

Current School *

Current Grade *

Preferred Instrument of Study *

Previous Music Experience

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Parent Name (if applicable)

Email Address *

Best Phone Number *

Billing Contact (if different from Parent Name)

Billing Address (if different from Student Address)

City

State VirginiaNorth CarolinaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontWashingtonWest VirginiaWisconsinWyoming

ZIP

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How did you hear about AOM?

Notes or comments for the Registrar:

Comment here if you would like to list a preferred location, teacher or start date.

If you are human, leave this field blank.

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