Conference RegistrationRegister Below "*" indicates required fieldsAttendee Registration InformationName* First Last Company*Job Title*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Phone*Type*Select one:CellWorkHomeSelect your ticket:* Clinical Attendee ($95): Includes exhibit hall access, networking lunch, and clinical presentations. Must be a clinical professional. Exhibit Hall Pass ($150): Exhibit hall access with networking lunch. Does not include clinical presentations. Non-Clinical Attendee ($195): Includes exhibit hall access, networking lunch, and clinical presentations.Feel free to reach out to [email protected] if you have a group of more than 6 people and are interested in a group rate.Practice Setting*Select one:Private PracticeGroup PracticeHospitalTreatment CenterSchoolResearchOtherClinical Job Title*Select one:PsychiatristPsychologistSocial WorkerTherapistCounselorInterventionistCase ManagerED ConsultantWhich of the networking event(s) are you planning on attending, if any?Click here to learn more about the Leadership Workshop. Leadership Workshop on Wednesday, June 12th from 12pm - 6pm (+$199) Poolside Munch & Mingle on Thursday, June 13th from 11:30am - 3pm (No Charge for Registrants) Opening Reception on Thursday, June 13th from 5pm - 7pm (No Charge for Registrants)Are you planning on receiving CEU's from our presentations?* Yes NoPayment InformationClinical Attendee Registration Fee Price: Exhibit Hall Pass Price: Non-Clinical Attendee Registration Fee Price: Leadership Workshop Price: Do you have a coupon code?* Yes NoCoupon code Total Credit CardCardholder NameCard DetailsCancellation & Communications Policy* By checking this box, I agree to the Cancellation & Communications Policies.I understand that cancellation requests must be received via email at [email protected] or postmarked via mail by May 12, 2024 to receive a refund. All refunds will be subject to a 10% cancellation fee. Attendees wishing to transfer their registration may do so without penalty if done by June 10, 2024. I also understand that I will receive communications from this year's Conference Partners and Sponsors leading up to and after the Conference.Contact Sharing for Networking Purposes (Optional) By checking this box, I agree to share my contact information with exhibitors after the conference.I agree to share my contact information with PIT Conference 2024 exhibitors after the conference so that I can receive communications from them.