Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Nariman

Last name:

Hashemi

Date of Birth:

2011-09-11

Parent Information

First name:

Ali

Last name:

Hashemi

Parent / Guardian's Email:

hashemi158@gmail.com

Contact Number:

6043393536

Relationship to student:

Father

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

64-3400 Devonshire Ave

Address Line 2:

ZIP / Postal Code:

V3E0L1

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:

Search Engine (Google, Bing, etc.)

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