Customer Enquiry Form

PLEASE NOTE: The online form below is an EXPRESSION OF INTEREST, not an official enrolment form.

Learning Music Australia will be in touch to discuss your needs further and to start the enrolment process.

For questions, please contact Learning Music Australia on (08) 8395 4993 or admin@learningmusicaustralia.com

Course name (please select)

Student's name

First NameMiddle NameLast Name

Your current school year level (if applicable)

Gender

MaleFemale

School

Student address

Street Address

Street Address Line 2

CityState

Post CodeCountry

Home Phone

School Phone

Student's Mobile Number

Date of Birth

DayMonthYear

E-mail Address

Is the student able to perform all tasks of their chosen course:

YesNo

If NO, please provide details

Does the trainer need to contact the school VET Coordinator for further information regarding any information supplied?*

YesNo

If so please provide VET coordinators name and contact details below.

Finally, how did you hear about us?

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