Registration Form & Mailing Instructions

Nov 10 – 15, 2020
3rd Chakra, Being a Force for Good and Mastering your 3 Dimensional World.

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





Primary Phone__________________________________________

Alternate Phone__________________________________________


Name for ID Tag______________________________________

Emergency Contact Name__________________________________

Emergency Contact Phone #__________________________________

$1345 Early Bird Fee (due, in full, October 14, 2020.)
$1395 Regular Fee (due by November 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)
Vegan ($25 extra)
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

Please email or mail application materials and payment to:

Email: OR

Jean Hollister
1105 Merlot Court
Moore, SC 29369

Credit Card Payments: For security if emailing your application, please call me at (513)284-1394, with your credit card number or split in two different emails or texts. Thank you, Jean

Out of country? If you download and use WhatsApp, calls and texts are free! 1 513 284-1394 US country code is 1.