Piano Course Booking Form

Please Print and complete this form and and post, fax or Email to:

The Secretary - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Tel/Fax: 01923 822268
Nelly Ben-Or Piano Courses
23 Rofant Road, Northwood, Middlesex HA 6 3BD, England
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Application Form

Name: _________________________________________________________________

Address: _______________________________________________________________

______________________________________________________________________

Telephone Number: ____________________________

Fax Number: __________________________________

Email: _______________________________________

Professional Status_________________________________________________

Have you had any lessons in the Alexander Technique?_____________________

Amount of cheque/money order enclosed (see Fees) made out to;
Nelly Ben-Or Piano Course

£ __________________

(Cheques etc. from abroad must be drawn in pounds sterling on a bank with
a branch in England.) Please ask the course secretary for details of making a direct bank transfer.

Signature: _______________________________________

Date: ___________________________________________