* Student Name

Parent/Guardian Names

* Email

* Mailing Address

* Zip Code

* Home Phone

Cell Phone

Work Phone

Full Tuition (One Term)  30 Minute Lessons - $270
45 Minute Lessons - $390
60 Minute Lessons - $510

Monthly Tuition (To be paid at the beginning of the month)  30 Minute Lessons - $90
45 Minute Lessons - $130
60 Minute Lessons - $170

Payment Type  Cash/Check
Credit Card

Paperless I would like my future transactions and confirmations to be paperless - Please email me important information.

Policy I have read, understand and agree to the Eugene Suzuki Music Academy's Studio Policy *

I give my permission for photographs and videos taken of my children and/or members of my family, to be shown or used in educational and promotional material used in connection with Eugene Suzuki Music Academy.

Scheduling  I would like to keep my current lesson time.
I would like to keep my current time, but may have some flexibility.
I need a new lesson time. Here are 3 days and times that would work for me (please list different times):

Day 1

Time 1

Day 2

Time 2

Day 3

Time 3

* Verify

Comments