Registration Form

I am a:

Adult Student (ages 19+)

Adult Student Information

first name:

Behrang

last name:

Khalili

Enter Email:

behrang.khalili@yahoo.com

Phone number:

7785132574

Date of Birth:

2025-01-07

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

2975 Atlantic Ave

Address Line 2:

ZIP / Postal Code:

V3B 0C5

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?

Twice a week

Which days are you available for lessons?

Wednesdays, Saturdays

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

Word of Mouth

Referrer:

Cgg