Registration Application Form

March 28-29, 2026 | Essex, Maryland

Important Information Before You Begin

This is a clinical assessment application, not a standard event registration. Please set aside 15-20 minutes to complete this form thoughtfully. Your responses help us determine whether this integrative approach is appropriate for your unique situation and ensure we can provide you with the individualized attention this experience requires.

Please note:

  • Submission does not guarantee acceptance
  • Applications are reviewed in the order received
  • Enrollment is limited to 50-100 participants
  • Approved applicants will receive confirmation within 1-2 business days
  • All information is confidential and HIPAA-compliant

Fill The Registration Form Below

Sign Up
Chronic Pain Relief Experience - Registration Application

Contact Details

Attestation & Signature

After Submission - What happens next?

  • Confirmation: You will receive an immediate email confirming we received your application
  • Review: Our clinical team reviews your application within 5-7 business days
  • Decision: You will be notified of acceptance, waitlist status, or alternative recommendations
  • Enrollment: Accepted applicants receive payment instructions and must confirm within 72 hours to secure their spot
  • Preparation: Confirmed participants receive detailed preparation materials 2-3 weeks before the event

Questions? Contact us at contact@anchoredself.org or (443) 531-7599

Thank you for your interest in the Chronic Pain Relief Experience. We look forward to reviewing your application.