PREMIER’S ANNUAL CHRISTIAN SUMMIT

Leadership Registration

Monday, May 4, 2026

Westerner Park – Red Deer, Alberta

(VIP Breakfast on Tuesday May 5, 2026)

Please complete the form below to reserve your ticket.

Personal Information

First Name

Last Name

Email *

Phone *

Province *

City *

Postal Code

Church / Organization Information

The church you attend: *

Denominational affiliation *

City your church is located: *

Province your church is located: *

Organization name you are representing at the summit: *

Leadership Roles

Your Role (Please state your leadership role; list multiple if applicable (ie. Senior Pastor,Elder / Board Member, Christian School Leader, Ministry Director, Denominational Leader,Christian Business Leader; Government Official, Media, Other) *

Sponsorship Information

Sponsor Code (if applicable) If your table has been sponsored, please enter the code provided to you.

Event Details

Will you attend: *

Dietary Restrictions

Accessibility Requirements

Additional Information

How did you hear about this event? *

Confirmation

I consent to photography and media use for event coverage.

By submitting this form, you agree to receive future communications from other initiatives by Michael Clark or Christian Impact Network. You may unsubscribe at any time.

You will receive a confirmation email upon successful registration.

Contact: [email protected]