Bensax Music Academy Registration
Register to our music school from below
Name of parent
First Name
Last Name
Name of student
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
MM/DD/YYYY
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Do you agree to opt-in to receive Text messages? You may opt-out at any time by replying "STOP".
Please Select
I agree to opt-in
I do not agree to opt-in
Email
*
example@example.com
Choice of Instrument
*
Guitar
Piano
Bass Guitar
Drums/Percussion
Saxophone
Ballet/Jazz
Vocals
Sound Engineer
Latin Ballroom
Choir Conductor
Violin
TYPE OF LESSONS
Group Lessons (2-12 students)
Private Lessons (1 on 1 with instructor)
POLO SIZE
Youth Size
SIZE 6/7
SIZE 7/8
SIZE 9/10
SIZE 12/14
SIZE 16
Adult Size
SM
M
L
XL
XXL
3XL
PLEASE SIGN
*
Registration Fee: $50.00
prev
next
( X )
Registration Fee
$
50.00
This fee covers administrative expenses, your BMA polo shirt, your binder, and ensures smooth integration into our dynamic community.
Total
$
0.00
Payment Methods with ZELLE or Cash App
Please Select
ZELLE to legacy@bensaxmusicacademy.com
Cash App: $bensaxmusicacademy
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Continue
Continue
Should be Empty: