Register #8811 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Karen

Last name:

Osanlou

Date of Birth:

2017-04-14

Parent Information

First name:

Shokoofeh

Last name:

Aghaahmadi

Parent / Guardian's Email:

Shokoufeh1370@yahoo.com

Contact Number:

2365124035

Relationship to student:

Mother

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

British Columbia

Address Line 1:

3198 Sylvia Place coquitlam

Address Line 2:

ZIP / Postal Code:

V3E 2R4

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?

Once a week

Which days are you available for lessons?

Fridays

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

Social Media (Instagram, Facebook)

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