Register #8803 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Farbod

Last name:

Ghazi Khani

Date of Birth:

2014-07-09

Parent Information

First name:

Alinaghi

Last name:

Ghazi Khani

Parent / Guardian's Email:

kghazikhani@yahoo.com

Contact Number:

7788658312

Relationship to student:

Father

Address

Country:

Canada

City:

Port Coquitlam

State / Province / Region:

BC

Address Line 1:

2789 Shaugnessy St

Address Line 2:

ZIP / Postal Code:

V3C 0C3

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:

Vialon

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

Once a week

Which days are you available for lessons?

Saturdays

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

Referral

Referrer:

Ayda