Registration Form & Mailing Instructions

October 14-19, 2012 — Having Your Feet on the Ground so You Can Soar — Grounding and Insight

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.

  1. A recent head & shoulder, individual color photo.
  2. 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





Home Phone__________________________________________

Work phone__________________________________________


Name for ID Tag______________________________________

Emergency Contact Name__________________________________

Emergency Contact Phone#__________________________________

$975 Regular Fee
Kama’aina Rate, $50 off.

Check # ______ payable to HLCC and/or

MC Visa Disc AMEX
CC#_________________________________Ex. Date________

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

Sunday Arrival:
I will arrive in time for the Welcome Luau Dinner on Sunday at 5:30PM.

Room Share:
Would you like to share a room?    Yes    No
If yes, please give your gender and age.    Gender:    M    F     Age:_____

To register for this workshop please fill out the form above and send (mail, fax or email) it
along with your payment AND color photo to:

Rama Thiruvengadam, MD
PO Box 390988
Keauhou, HI 96739

Fax toll-free to (866) 873-7376)

Questions? Please feel free to phone Rama Thiruvengadam, MD at (808) 443-8949, or email