Client Name * First Name Last Name Email * Phone * (###) ### #### Time Zone * Atlantic Eastern Central Mountain Pacific Alaska Hawaii Student First Name * Enter one or more names, or enter N/A if only requesting transcription services. Student Birth Year * Enter one or more birth years, or enter N/A if only requesting transcription services. Service Requested * Select one or more. Piano Lessons (Online) Piano Lessons (In-Home) * Transcription Services Experience Level * Select one or more. Beginner Intermediate Advanced Favorite Genres Select one or more. Classical/Traditional Jazz/Blues R&B/Soul/Funk Rock/Pop Alternative/Indie Country/Americana/Folk Movies/TV/Video Games Referred By Please provide the name of the person who referred you, if applicable. Waiting List Would you like to be added to the waiting list in the event a time slot is unavailable? Yes No Additional Information Thank you! *In-home lesson availability is based on applicant’s location, which can be provided during free online consultation.