The Embodied Actor 2 Day Intensive Workshop Application Form

The Embodied Actor 2 Day Intensive Workshop

Fill out the form carefully for registration
Please provide some personal details
Your Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your E-mail
example@example.com
Mobile Number

Area CodePhone Number
Phone Number

Area CodePhone Number
Please describe yourself in a few words.
What types of workshops related to personal development, mindset, somatics, and regulation have you previously attended?
How do you feel personally about practicing holistic wellness modalities such as mediation, improvised dance, and breathwork?
Please upload a scene reel

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Please upload a current headshot (this does not need to be a professional studio photo)

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Once you have submitted this form, Shakira will be in touch to request a short virtual connection with you lasting no more than 15 minutes to talk about your application.

Once this occurs, if your application is accepted, a non-refundable fee of $50 will be required immediately to secure your spot. Final payment will be due 2 days from the commencement of the course date (13th June 2026).
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