$36.00 30-Minute Trial Lesson Registration * Last Name * Parent's Name * Student's Name * Student's Birth Month * Student's Birth MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember * Student's Birth Day * Student's Birth Day12345678910111213141516171819202122232425262728293031 * Student's Birth Year * Medical Conditions * Medical Conditions Yes No * Medical Description * Instrument/Class * Best Phone Number Spouse's Name Spouse's Phone Number * Street Address * City * State * Zip * How you heard of us? * Email Address Spouse's Email Address * I agree to North Main Music's Policies & Procedures below. * I agree to North Main Music's Policies & Procedures below. YES Go to Payment Site