Family Revival Conference Registration | Jesus Redeems Canada

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Family Revival Conference

Registration Form

October 30 - 31st, 2026

Your Details

First Name*

Last Name*

Gender

Date of Birth

Age Group

Phone Number*

Email Address*

Meal Preference

Home Address

Address Line 1*

Address Line 2

City*

Province*

Postal Code*

Additional Members Attending

Add anyone attending with you. Choosing Child as the member type opens the children’s ministry questions for that person.

Add a member attending with me

Attendance Details

Which day(s) will you attend?

October 30

October 31

Both days

Consent & Communication

I consent to receive updates via Voice Call / SMS / email

Yes

No

Optional Information

How did you hear about the conference?

Interested in Volunteering?

Yes

No

JESUS REDEEMS MINISTRIES

+1 289-201-0229

info@jesusredeems.ca

Jesus Redeems Ministries,

PO Box 30061, East Main PO, Grimsby ON L3M0A3

Thanks for submitting!

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