School Location        : ___________________________________

Start Date                : ___________________________________

Student Name          : ___________________________________

Student Age             : ____________________________________

Parent Name           : ____________________________________

Home Address         : ____________________________________

                                   ____________________________________

Home Phone            : (____) ______________________________

Work Phone            : (____) ______________________________

Courses (please specify)

_______________________________            

______________________________   $

Registration Fee (includes beginning book)                                                             $ 25

Total                                                              $

Please send the enrollment form and payment to:

Concert Music School        PO Box 1407                     Sunset Beach, CA 90742

You may fax the enrollment form to (714) 377-4941 or email us at:

enroll@concertmusicschool.com