Name

First Name

Last Name

LESSON TYPE?

FEEL FREE TO CHECK ALL THAT INTEREST YOU...

PIANO BEGINNER

GENERAL MUSIC LESSON FOR A CHILD

GENERAL MUSIC FOR ADOLESCENT

GENERAL MUSIC LESSON FOR A GROWN-UP

STARTING A FAMILY BAND

CLARINET

SAXOPHONE

CLAW-HAMMER BANJO

UKULELE

GUITAR BEGINNER

FOLK MUSIC THEORY

CLASSICAL MUSIC THEORY

MUSIC FOR TODDLER

MUSIC THERAPY

HAVING FUN WHILE LEARNING

GROUP OR INDIVIDUAL LESSON?

INDIVIDUAL

GROUP

FREQUENCY

HOW OFTEN WOULD YOU LIKE A LESSON?

ONCE/WEEK

EVERY OTHER WEEK

ONCE/MONTH

OCCASIONALLY

JUST ONCE

SEMESTERS OFFERED

LESSONS CAN OCCUR ANYTIME WITHIN THESE DATES

OCT - DEC

JAN - MARCH

APRIL - JULY