RockonAmerica 
Fill out this form and click "submit" at bottom of page. We will contact you within 24 hours with info on group times and starting dates that match your profile!
Email Address
Name:
Age:
Grade:
If under 18, parent's email address
Date
Address
City, State
Zip
Tel.
Cell# & Emergency #
Check which level you're interested in. Level 1 (No previous playing experience) Level 2 (Have had some lessons or self taught)
If you already have some playing experience, for how long and on what instrument? If "no experience" what instrument would you like to try?
Check which styles of music you like!
Other
Name 3 songs you might like to do with your group.
I sing...
I make up my own music..


I have friends that I want to be with me in this group.

If YES what are their names?
Best day(s) for me to Rock are (check as many as possible)...
Where did you hear about RockonAmerica?







If under 18 please have your parent confirm this information by email to RockonAmerica@optonline.net 
If under 18 do you have your parent's permission to enroll in this program?

I understand that this program is not free!  (However there is no fee to register here)!

Any questions? Thank you!


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