Q1. Please enter the following: First Name, Last Name  <br/><b>First Name:</b><input type="text" name="fname" value="CBLR" size="40" /><br/> <br />
                <b>Last Name:</b> <input type="text" name="lname" value="Attendee 2017" size="40" /> <br/><br />Q2. Please enter the following: Email  <br/> Email:<input type="text" name="email" value="vanessa@christianregency.com" size="40" /><br/>  <br />Q3. Place Quote Below:  <br/>
                    <textarea rows="3" name="3" cols="50" style="margin-right: 40px; vertical-align: middle;">After attending CBLR, I had a sense of peace that I had not felt prior. I needed those few days of just communing with God and with other Christians. I want to encourage you to continue this work that God has given you. I will be there next year! </textarea>
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