Register #9096 - vancomusic

Registration Form

I am a:

Adult Student (ages 19+)

Adult Student Information

first name:

Verónica

last name:

Corrales

Enter Email:

veronicacorralesrguez@gmail.com

Phone number:

(778 302 5958

Date of Birth:

1985-05-08

Address

Country:

Canada

City:

Vancouver

State / Province / Region:

Bc

Address Line 1:

128 west cordova street

Address Line 2:

ZIP / Postal Code:

V6B OE6

Program Selection

I am looking for:

Hybrid Lessons

What level would you like to register?

Level 1-4

Please write the program or instrument you are interested in:

Piano

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

Thrice a week

Which days are you available for lessons?

Monday, Tuesday, Wednesdays

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

Search Engine (Google, Bing, etc.)

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