Skip to main content

Team 17 Student Registration Form

Registration Form Team 17

Student Information

This registration form is required for each participating student after enrollment has been purchased.
Purchaser's Name (If different from registrant)
Registrant Name(Required)
Gender(Required)

I am 18 years or older.(Required)
Please select your communication preferences.(Required)
Mailing Address(Required)
Is your mailing address the same as your billing address?(Required)
Are you a new or review student for this course?(Required)
MM slash DD slash YYYY
Enter the start date of class.
Payment Collected By(Required)

Head of Household or Business Member Information

This section is for those registering under another individual at the same home address or business address. * Please skip this section if not applicable.
Address of Head of Household or Business Member (If different from mailing address)

Course and Membership Information

Is your Concept-Therapy membership current for the present year?
Course Tuition Purchased

* * * For membership and/or lodging questions, please contact the Concept-Therapy Institute office at 210-698-2294.

* * * Recording Policy: This class will be recorded and/or broadcasted. During this class, it is possible that you may be videotaped, audio recorded or photographed. Your registration serves as permission for Concept-Therapy to make and use these recordings to create and market its products.

I acknowledge and accept the recording policy stated above.(Required)