Contact

If you might be interested in lessons, please submit the form below.  Use the comments section to include any additional information about the student that may be useful.  Be sure to check the Calendar page link above to check the current schedule before suggesting a lesson time. Submission of this form does not imply a commitment to take lessons.
Student's First Name:
Student's Last Name:
Parent's Name(s) (if applicable:)
Which parent will bring the student to lessons?:
Home Address 1:
Home Address 2:
City:
Zip Code: (5 digits)
State:
Student's School (if applicable):
Home Phone:
Cell Phone:
Cell Phone:
Email:
How long has the student played the saxophone?
 New student
  1-2 years
  3 year plus
 Your Primary Instrument
 Alto Sax
  Tenor Sax
  Baritone Sax
 Preferred Lesson Day (be sure to check the Lesson Schedule page for availability)
 Monday
  Tuesday
  Wednesday
  Thursday
  Friday
 Preferred Lesson Time
 3:00
  3:30
  4:00
  4:30
  5:00
  5:30
  6:00
  6:30
When would you like to begin lessons?
Comments:


Mike Stopher
5773 Flairstone Dr. SE
Salem, OR 97306
Phone: 503-999-3591
Copyright . Mike Stopher. All rights reserved.
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