Register #8788 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Iris

Last name:

Farahavar

Date of Birth:

2019-08-01

Parent Information

First name:

Nazly

Last name:

Pourghorban

Parent / Guardian's Email:

na.pourghorban@gmail.com

Contact Number:

6044455519

Relationship to student:

Mother

Address

Country:

Canada

City:

Port Moody

State / Province / Region:

BC

Address Line 1:

438 Carlsen Pl, Port Moody

Address Line 2:

ZIP / Postal Code:

V3H 3Z9

Program Selection

I am looking for:

In-person Lessons

What level would you like to register?

Preliminary

Please write the program or instrument you are interested in:

Piano

How many days a week would you like to have classes?

Twice a week

Which days are you available for lessons?

Saturdays, Sunday

We'd love to know how you heard about us:

Search Engine (Google, Bing, etc.)

Referrer:

Lena