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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.
• For new students, your typed thoughtful responses to the questions below on a separate paper, limiting your answers to 1-2 paragraphs per question.

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#__________________________________

$995 Early Bird Fee (due, in full, June 19, 2015) — If you wish, you can pay a deposit of half the registration fee $497.50 anytime, with the balance due July 19, 2015.
$1075 Regular Fee
Commuters add $125

Check # ______ payable to Liz Chazen and/or

MC Visa Disc AMEX

CC#____________________________________   Ex. Date:__________

Dietary Preference:
We cannot accommodate special diets. But Liz will do her best to have the following available for you. Please circle your preference.
All foods
Gluten-Free
Vegetarian

Room Share: Would you like to share a room?     Yes     No
If yes, please give your gender and age.   Male   Female    Age: _________

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

OR,

Email Lizchazen@gmail.com to register with email,
please copy and past this registration filled out completely.

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