Written/Chat Lessons: Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please reach out to hello@miastegner.com with any questions, concerns, or technical difficulties.

Name / Nickname *

Pronouns *

she/her/hers

he/him/his

they/them/theirs

Other:

Required

Email Address *

Discord Username + 4-Digit "Tag" (please create an account if you don't have one! This is what we'll be using to communicate. It's free!) *

What do you plan to pay for each lesson (in USD)? Pricing is PWYC, with a suggested range of $10-$30. It's okay if it changes, but I appreciate an estimate! *

How old are you? *

If you're under 18, do you have parent / guardian permission to work with me? *

Yes

I'm over 18

Required

If you're willing, please provide emergency contact information of a trusted adult. This is most applicable for minors. I will only refer to this information if I have extreme concerns regarding your safety or mental health. *

Tell me a little bit about yourself! Do you have any previous experience in songwriting? What do you hope to get out of these lessons? Is there anything else I should know about you? *

Please read this document, and then confirm below. https://docs.google.com/document/d/1BY1IEmd2eJKtUF5jdhvL9ZQMKUJl_Ezfsk_MoE4vEZc/edit?usp=sharing.

I have read the document, and agree with the outlined information

What happens now?

After you hit submit, I'll reach out via email (usually within 48 hours) to confirm that I received all the information I need and get connected on Discord. :)

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms