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To apply for this intensive, submit the following items along with your completed registration form and payment-in-full. Please submit all items together at the time of application.

• A recent head & shoulder, individual color photo.

We are sorry that incomplete applications cannot be accepted.

New Students: If this is your first intensive with Rosalyn and Ken, please provide the following additional typed information with your registration, limiting your answers to 1-2 paragraphs per question.

• 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____________________________

Home Phone__________________________________________

Work phone__________________________________________

Email_______________________________________________

Name for ID Tag______________________________________

Emergency Contact Name__________________________________

Emergency Contact Phone#__________________________________

$1275 Early Bird Fee (due, in full, Jan 10th)
$1350 Regular Fee

Check # ______ payable to HLCC and/or

MC Visa Disc AMEX

CC#_________________________________ Security Code (3 digit code on back)_____

Ex. Date________

Dietary Preference:
All foods Vegetarian, including dairy & eggs (Sorry, we cannot accommodate special diets ).

Sunday Arrival:
I will arrive in time for 5:30 P.M. dinner on Sunday.

To register for this workshop please fill out the form above and mail it
along with your payment, AND color photo to the following address.

Liz Chazen
18 Cambridge Lane
Lincolnshire, Illinois 60069

Questions? Please feel free to phone Liz Chazen at (847) 767-3663.