Registration Form & Mailing Instructions

August 14-19, 2022
3rd Chakra, Being a Force for Good and Mastering your 3 Dimensional Worlds

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_________________________________________Cell? ____

Alternate Phone__________________________________________


Name for ID Tag______________________________________

Emergency Contact Name__________________________________

Emergency Contact Phone #__________________________________

$1392 Early Bird Fee (due, in full, July 14, 2022)
$1442 Regular Fee (due by August 14, 2022) -- However, you must pre-register to insure space.
$700 Deposit to hold space, balance due according to above dates
$270 Additional for single room, due with deposit
$25 Additional for gluten-free and vegan 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 (more limited because of peak season) Double

IMPORTANT: Because of necessary date changes and starting on a Sunday, we are unable to book any additional hotel dates on your behalf as part of the workshop reservation. August is peak season and Friday/Saturday nights are often booked way ahead by weekenders. If you'd like to arrive in advance of Sunday or extend your trip, contact Hueston Woods directly at 1 513 664-3500. If extra rooms are available, your credit card must be used to secure any nights outside of intensive dates. Please let them know that you are attending the Healing Intensive, so they can try to keep you in the same room.

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.