Register #9474 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Milan

Last name:

Aghaee

Date of Birth:

2015-04-15

Parent Information

First name:

Negar

Last name:

Sadi Nejad

Parent / Guardian's Email:

n.sadinejad@gmail.com

Contact Number:

5875807576

Relationship to student:

Mom

Address

Country:

CA

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

609-3007 glen dr

Address Line 2:

ZIP / Postal Code:

V3B 0L8

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?

Monday

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

Referral

Referrer:

Niushan