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Lesson Request Form
Would you like to take lessons at Mike's Music? Please fill out this form and we will get right back to you!
First Name
Last Name
Email Address
Daytime Phone
I Would Like Lessons For
Bass (upright)
Bass (electric)
Cello
Clarinet / Bass Clarinet
Drum Kit & Percussion
Euphonium
Flute
Guitar
Harp
Piano
Oboe
Saxophone (alto)
Saxophone (tenor)
Trombone
Trumpet
Tuba
Violin
Viola
Voice
Other
Student's Current Skill Level
Total Beginner
Played Before
Advanced
Preferred Time of Day
Morning
Early Afternoon
After School (4pm-6pm)
Evening (6pm-8pm)
Please Select Preferred Days Below:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Not enough questions above? Enter any additional comments here:
Repeat Email Address