Returning Student Movement Registration Form

Returning Student Rosen Method Movement Registration Form

Your answers to the registration form questions are confidential and will only be seen by teachers and staff.

Name

First Name

Last Name

For which movement intensive/workshop are you registering?

Email

Phone

(###)

###

####

Date of Birth

MM

DD

YYYY

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Emergency Contact

First Name

Last Name

Emergency contact's relationship to you

Emergency contact's phone number

(###)

###

####

Have there any been any significant changes for you since your last intensive?

Physically, mentally, emotionally, or spiritually? Please describe if yes.

Has Rosen Movement been a part of your life since the last intensive?

Is there anything else that is currently going on that would be helpful for us to know?

Please sign and date this registration form.

Your digital signature confirms that you have completed this form accurately and honestly, and that you have reviewed our cancellation and refund policies.

Date of signature

MM

DD

YYYY

Would you like to receive information about future Rosen Method Open Center events?

Yes

No

Please refer to the RMOC website for our cancellation/refund policy.

Attendance is required from the beginning to the end of the intensive.