Advanced London Piano Course - Booking Form
Workshop leader: Penelope Roskell

Venue: The Studio, 66 Queen Elizabeth’s Walk, Stoke Newington, London N16 5UQ
Email address *
Date of the course you are applying for *
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Name *
Your answer
Address & postcode *
Your answer
Telephone number/s *
Your answer
How did you hear about the course *
Your answer
What age are you *
Piano qualifications and experience: *
Your answer
Repertoire you would like to play during the course (time permitting):
Your answer
Other pieces you have been working on recently: *
Your answer
What stage are you at? *
Are you currently having lessons? *
Are you working towards any particular concert, exam or audition at the moment? *
Your answer
Do you have any particular problems/concerns that you would like to discuss during the course (time permitting)?
Your answer
Please sign (simply type your name in full) and date this form to signify your acceptance: *
Your answer
Are you happy to be added to the mailing list for news, events, courses and concerts? *
Thank you for applying for a course
Booking: Once your application has been acknowledged and availability confirmed, you will be asked to confirm your place with payment in full.

Refunds: Cancellation made at least four weeks before the start of the course will receive a 50% refund. There will be no refund due for cancellations made within 28 days of the beginning of the course.
A copy of your responses will be emailed to the address you provided.
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