Suzuki Graduation Form 2005 Page 2
ABN 14 080 413 955
TEACHER'S NAME:
__________________________________________________
Phone:
__________________________
FEES
LEVELS 1 2
$42 +
ACCOMPANIST $10
LEVELS 3 5
$48 +
ACCOMPANIST $15
LEVELS 6+
$63
+ ACCOMPANIST
$20
All prices include GST
M/ship
No.
First Name(s)
BLOCK LETTERS
PLEASE
Family Name
BLOCK LETTERS
PLEASE
DOB
Grad Lvl
Instr
Live/
Tape
FEES
Grad Accomp.
Sub-total
A B
TOTAL
(A + B)
TIMES TO BE AVOIDED FOR SPECIFIC STUDENTS (Live Graduations) (EXCEPTIONAL CIRCUMSTANCES ONLY)
NAME REQUEST
Teacher's Authorising Signature:
