Suzuki Music Program of Los Angeles

Suzuki Music Program of Los Angeles Chapter

SMPLA Registration Form - SUBMIT ONE FORM PER PERSON PLEASE
Student Name *

First Name Last Name
Gender *
Birthday *
MM/DD/YYYY
Parent 1 Name *

First Name Last Name
Parent 2 Name

First Name Last Name
Parent Email *
example@example.com
Additional Email (optional)
example@example.com
Parent Phone Number *

- Area Code Phone Number
Parent Secondary Phone Number

- Area Code Phone Number
Street Address *
City *
Zip Code *
TEACHER NAME *

First Name Last Name
TEACHER Email
example@example.com
TEACHER Phone Number

- Area Code Phone Number
Instrument *
Current Piece and Book *
Questions/Comments
You are required to read the following information carefully and make sure that you understand it fully and agree to it before allowing your child(ren) to participate in this activity or program. By submitting this form, you are signing this form electrionically and agree that you have read and understand the General Libality and Medical Treatment Informed Consent and Photo/Video waivers:

READ WAIVERS

My Products

Annual SMPLA Enrollment Fee $ 77.00

Annual Workshop Tuition - Select only for 1st student in family $ 390.00

Sibling Annual Workshop Tuition - Select only if you have already enrolled the 1st student $ 340.00

Red Tie for Outside Performances & Concerts $ 15.00

FREE SMPLA T-Shirt for Workshop Enrollees (if needed) Free

T-Shirt

SMPLA T-Shirt for those not attending Workshop $ 10.00

T-Shirt - Youth

Parent Education Seminar $ 35.00

Enter coupon

Total $ 0.00

Suzuki Music Program of Los Angeles Chapter