Consultant Receipt Submissions Use the form below to submit your travel receipts for the 2026 Partners In Treatment Conference Therapeutic Consultant Events. Please email [email protected] with questions. Step 1 of 3 33% Full Name(Required)Email(Required) How many receipts are you submitting? 1 2 3 4 5 Receipt 1 InformationDate(Required) MM slash DD slash YYYY Expense Category(Required)HotelFlightTaxiAmount(Required)Description(Required)Upload Receipt 1(Required)Max. file size: 100 MB. Receipt 2 InformationDate(Required) MM slash DD slash YYYY Expense Category(Required)HotelFlightTaxiAmount(Required)Description(Required)Upload Receipt 2(Required)Max. file size: 100 MB. Receipt 3 InformationDate(Required) MM slash DD slash YYYY Expense Category(Required)HotelFlightTaxiAmount(Required)Description(Required)Upload Receipt 3(Required)Max. file size: 100 MB. Receipt 4 InformationDate(Required) MM slash DD slash YYYY Expense Category(Required)HotelFlightTaxiAmount(Required)Description(Required)Upload Receipt 4(Required)Max. file size: 100 MB. Receipt 5 InformationDate(Required) MM slash DD slash YYYY Expense Category(Required)HotelFlightTaxiAmount(Required)Description(Required)Upload Receipt 5(Required)Max. file size: 100 MB. When we write the check, what entity or individual should we make it out to?(Required)Where should we mail the reimbursement check?(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Receipt Legitimacy(Required) I certify that the receipts submitted are legitimate, original, unaltered receipts incurred solely for this event during the period of April 21-24, 2026, not used for any other event, and that all information provided is accurate to the best of my knowledge.Reimbursement Terms(Required) I understand that I am eligible for a maximum reimbursement of $650-$950 (depending on which days of tours I attended), which may include travel expenses, and that payment will only be issued after the conference concludes if I attend the tours, speed dating, and conference day on Friday; however, I acknowledge that I may not receive this stipend if I violate any conference rules outlined in the Terms and Conditions (https://pitconferenceaz.com/terms-conditions).