Please review the terms below. By checking the box and clicking submit, you legally agree to the Shake The RooM Media Release and Waiver. This form helps us prepare an intentional, impactful interview. Your Name Your Email Address Preferred Name / Nickname Your Phone Number Social Media Profile (Optional) Profession / Title Briefly describe who you are and what you do. What is your current mission, brand, or focus right now? What key moment or challenge shaped your journey? What lesson or message do you want the audience to leave with? Anything you do NOT want discussed on camera? Links or projects you want us to highlight:
