Tuesday, April 26 – Thursday, April 28, 2022 October 31 ...

Two Ways to Register By email: Scan and email PDF to heather.martin@ By mail: 629 Camino de los Mares, Suite 309, San Clemente, CA 92673

Need More Forms? 4 Photocopy this form

: Download a registration form from

One name per registration form please. Make copies for additional guests.

April 26 ? 28, 2022 Louisville, Kentucky

The Galt House

First Name:

MI: Last Name:

Nickname (for badge):

Title:

Organization (do not abbreviate):

Mailing Address:

City:

State/Prov.:

Zip/Postal Code:

Country:

Phone: ( )

Mobile Phone: ( )

Are you in CCNL? c Yes c No

Is this your first Outcomes conference? c Yes

Email:

One unique email address required for each registrant

If you have a disability-related request, please call (949) 487-0900, ext. 118.

Tuesday, April 26 ? Thursday, April 28, 2022

Three-day Leadership Experience (Tues. ? Thurs.)

Includes access to all high-impact educational sessions, peer networking opportunities, devotions, specialized leadership intensives, exhibit hall and all general sessions

c Member c Non-Member

c Spouse

Pricing Thru Final Conference Your

October 31, 2021 Pricing

Fee

$749

$899

$

$959

$1,099

$399

$399

For more information on each registration option and what is included, visit .

c Men's Breakfast -- Thursday, April 28 ($49)

+$

c Women's Luncheon -- Thursday, April 28 ($49)

+$

Questions? Call (949) 487-0900, ext. 118

c I would like to attend the CEO Forum on Wednesday. (Must be CEO/President/Executive Director or Senior Pastor.)

c Group of 5 members (purchase 4, receive 5th free) $ All 5 registrations must be submitted at the same time.

Total Amount Due: Choose check or credit card option below. Total amount must accompany registration form.

Total $

Two Ways to Pay (by check or credit card):

My check for $_________ is enclosed (Make payable in U.S. funds to Christian Leadership Alliance.)

Charge my c AmEx c MasterCard c VISA CC #

Exp: /

Security Code:

Name on credit card:

Phone: ( )

Credit card billing address, if different from above:

City:

State/Prov.:

Zip/Postal Code:

Country:

Cardholder signature:

Date:

Cancellations: In the event you need to cancel your registration, a refund (less $150) will be given to all written or faxed requests received by Christian Leadership Alliance on or before February 28, 2022. After that date, we are unable to give refunds. However, you may transfer your fees to anyone who is able to attend in your place. First transfer is complimentary; each subsequent transfer will incur a $25 fee.

Not a Member?

Go to and join online now.



Christian Leadership Alliance 629 Camino de los Mares, Suite 309

San Clemente, CA 92673 Phone: (949) 487-0900, ext. 118

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