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GENESIS SCPA Registration Form
Thank you for registering for private or classroom lessons. Completion of this form does not guarantee admittance. You will be contacted as to whether or not you have been admitted into GENESIS SCPA. Have a blessed day!
Name
*
Email
*
Phone
*
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City
*
State
*
Country
*
Name of Student
*
Select the Age Range of Student
*
Select The Age Range
5-8
9-12
13-17
18-28
29-45
46+
Field of study
Private Piano/Organ
Private Voice
Private Drums
Private Guitar
Private Bass
Song Writing/Composition Class
What is your lesson location preference?
Traditional Private Lesson
Group Discounted Lesson
Online Private Lesson
Online Group Lesson
Online lessons require you to have access to a well functioning computer with a web camera. You must also download and register with Skype @ http://www.skype.com
How did you learn of GENESIS SCPA?
Word of Mouth
MarkTJackson.com
Facebook
Instagram
Twitter
Newspaper
Email
Text Message
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