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Registration Form & Mailing Instructions

April 10-15, 2018
Topic to be Announced

To apply for this intensive, please submit a recent head & shoulder individual color photo (Emailing a jpeg would be great!) along with your completed registration form and either your deposit or payment-in-full. Please submit all items together at the time of application.

New Students Only: If this is your first intensive with Rosalyn and Ken, please provide the following additional typed information with your registration.

  • Do you have previous workshop experience with Rosalyn and Ken (where, when, and what subject)?
  • Please indicate your spiritual background. How have you evolved and where are you now? What work have you studied and with whom?
  • References - Please share with us how you found our community.

Registration Form

Name_______________________________________________

Address_____________________________________________

City________________________________________________

State/Prov_____________Zip____________________________

Primary Phone__________________________________________

Alternate Phone__________________________________________

Email_______________________________________________

Name for ID Tag______________________________________

Emergency Contact Name__________________________________

Emergency Contact Phone #__________________________________

$1345 Early Bird Fee (due, in full, March 14.)
$1395 Regular Fee (due by April 10) -- However, you must pre-register to insure space.
$700 Deposit to hold space, balance due according to above dates
$260 Additional for single room, due with deposit
$25 Additional for gluten-free diet

Check # ______ payable to Jean Hollister and/or

MC Visa Disc AMEX
CC#_________________________________ Ex. Date________ Sec. code________

Yes, I will bring a massage table.

Dietary Preference:
All foods (chicken or fish option at all dinners)
Vegetarian (including dairy & eggs)
Gluten-free ($25 extra)

I will arrive in time for 6 P.M. dinner on Tuesday.

Room Arrangements:
Single (limited #) Double

Roommate Preference____________________________________________
(If you checked double and do not have a roommate preference, one will be provided for you.)

Application Submission

Via Mail: Please mail application materials and payment to:

Jean Hollister
1105 Merlot Court
Moore, SC 29369

Email: JeanHollister42@gmail.com

Credit Card Payments: For security if emailing your application, please call me at (513)284-1394, with your credit card number. If using a previously submitted credit card, just write the last 4 numbers only on your application. Please add the new expiration date and security code if it has changed. Thank you, Jean.

Questions? Call Jean at (513)284-1394, or email JeanHollister42@gmail.com.