Register #8987 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Karen

Last name:

Aminafshari

Date of Birth:

2011-11-30

Parent Information

First name:

Elham

Last name:

Mousavi

Parent / Guardian's Email:

mousavie.elham@gmail.com

Contact Number:

7785127583

Relationship to student:

Mother

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

Bc

Address Line 1:

1190 lansdowne drvie

Address Line 2:

333

ZIP / Postal Code:

V3E1J7

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:

Violin

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

Once a week

Which days are you available for lessons?

Tuesday, Sunday

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

Search Engine (Google, Bing, etc.)

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