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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.
Name_______________________________________________
Address_____________________________________________
City________________________________________________
State/Prov_____________Zip____________________________
Primary Phone__________________________________________
Alternate Phone__________________________________________
Email_______________________________________________
Name for ID Tag______________________________________
Emergency Contact Name__________________________________
Emergency Contact Phone #__________________________________
$1275 Early Bird Fee (due, in full, March 17.) $1350 Regular Fee (due by April 14) -- However, you must pre-register to insure space.) $675 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) 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.)
Via Mail: Please mail application materials and payment to:
Jean Hollister583 Purcell AvenueCincinnati, OH 45205-2341
Email: jeanhollister@fuse.net
Credit Card Payments: For security if emailing your application, please call me at 513 471-3201 with your credit card number. If using a previously submitted credit card, just write the last 4 numbers only on your application. Please add the new expiration date and security code if it has changed. Thank you, Jean.
Questions? Call Jean at (513) 471-3201, or email jeanhollister@fuse.net.