Summit Registration Form
Welcome! Are you excited to visit a new city? To spend three days with other like-minded young men? To grow deeper in your faith? If your answer is yes, then we are excited to see you at the 3rd Young Men's Summit.

  1.  Please fill out this form to register for the summit.
  2. Please note the instructions for the recommendation letter as well. 
  3. There is no cost for this summit as we will feed and billet you. The only cost to you is getting to Grand Rapids. One request is that you bring about $50 USD to cover meals that take place outside of the Seminary at local restaurants. Your local consistory has been asked to consider assisting you with financial costs if costs are preventing you from coming. 
The Summit takes place from 3 pm on Tuesday (19th) until 12 noon on Thursday (21st).
The Summit will take place at the Puritan Reformed Theological Seminary chapel in Grand Rapids. 

If you have any questions you can send the organizers a direct message by emailing caprince13@gmail.com or scottdkt5@gmail.com 
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Email *
What is your full name?  *
What is your age?  *
What church (with city location) do you attend or are a member of?  *
What is the best phone number to contact you at? *
Do you have any medical concerns (physically or mentally) that we should be aware of? 
What is the name and phone number of your family doctor? 
Please share an emergency contact (parent/ other) and their phone number and email address.   *
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