" ROCK - ON AMERICA " Group Music

Please Print and fill this out and hand it to an EastCoast Music rep. behind the counter, thank you.

STUDENT'S NAME _________________________ AGE _____ DATE_____

ADDRESS ____________________________ZIP______TEL___________

EMAIL__________________________

Please Check:

1)I'm interested in Level 1 (No previous playing experience)

2) I'm interested in Level 2 (Have you had some lessons)

If You've already had some lessons, on what instrument and for
how long ?____________________________________________

3) Check what style(s) of music you like:  Rock      Pop     Blues     Jazz     Punk     Metal     Ska   Classic Rock     Funk     Fusion      Other _________________

5) I sing:    A little     A lot     No way

6) I make up my own music:    Yes      No      Would like to

7) I have friends that I want to be with me in this group:    Yes     No

8) Where did you hear about RockonAmerica...? Friend      Print Ad      TV Ad      Radio Ad       
Eastcoast Music Rep.      Poster      Website       Other _____________________

THANK YOU! YOU WILL BE CONTACTED SOON!

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