Q1. Please enter the following: First Name, Last Name  <br/><b>First Name:</b><input type="text" name="fname" value="Demo" size="40" /><br/> <br />
                <b>Last Name:</b> <input type="text" name="lname" value="Planter" size="40" /> <br/><br />Q2. At what age did you accept Christ?  <br/> <input type="text" name="2" value="15" size="40" /><br/>
      <br />Q3. Do you believe that the Holy Bible (Old and New Testament) is the inspired, inerrant and only infallible, authoritative word of God and the final authority in faith and conduct?    <br/><input type="radio" id="1411" value="1411" name="3" checked="checked"> <label for="1411"> Yes </label><br />
    <input type="radio" id="1412" value="1412" name="3" checked=""> <label for="1412"> No </label><br />
    <br />Q4. If not please explain.  <br/> <input type="text" name="4" value="Input" size="40" /><br/>
      <br />Q5. Do you believe there is only one true God, eternally existent and manifested in the triune Godhead, three persons equal in power and purpose and authority: God the Father, God the Son (Jesus Christ) and God the Holy Spirit?    <br/><input type="radio" id="1414" value="1414" name="5" checked="checked"> <label for="1414"> Yes </label><br />
    <input type="radio" id="1415" value="1415" name="5" checked=""> <label for="1415"> No </label><br />
    <br />Q6. If not please explain.  <br/> <input type="text" name="6" value="Input" size="40" /><br/>
      <br />Q7. Do you believe all have sinned and come short of the glory of God and are in need of salvation?   <br/><input type="radio" id="1417" value="1417" name="7" checked="checked"> <label for="1417"> Yes </label><br />
    <input type="radio" id="1418" value="1418" name="7" checked=""> <label for="1418"> No </label><br />
    <br />Q8. If not please explain.  <br/> <input type="text" name="8" value="Input" size="40" /><br/>
      <br />Q9.  Do you believe that salvation of mankind comes only by confessing the Lord Jesus Christ and believing that God raised Him from the dead?   <br/><input type="radio" id="1420" value="1420" name="9" checked="checked"> <label for="1420"> Yes </label><br />
    <input type="radio" id="1421" value="1421" name="9" checked=""> <label for="1421"> No </label><br />
    <br />Q10. If not please explain.  <br/> <input type="text" name="10" value="Input" size="40" /><br/>
      <br />Q11.  Do you believe in Jesus Christ's bodily resurrection and ascension to the right hand of the Father in heaven?   <br/><input type="radio" id="1423" value="1423" name="11" checked="checked"> <label for="1423"> Yes </label><br />
    <input type="radio" id="1424" value="1424" name="11" checked=""> <label for="1424"> No </label><br />
    <br />Q12. If not please explain.  <br/> <input type="text" name="12" value="Input" size="40" /><br/>
      <br />Q13. Do you believe in the resurrection of the dead to either eternal life with Jesus for the saved or eternal damnation in hell for the unbelieving lost?   <br/><input type="radio" id="1426" value="1426" name="13" checked="checked"> <label for="1426"> Yes </label><br />
    <input type="radio" id="1427" value="1427" name="13" checked=""> <label for="1427"> No </label><br />
    <br />Q14. If not please explain.  <br/> <input type="text" name="14" value="Input" size="40" /><br/>
      <br />Q15. Do you believe in the deity, virgin birth, and perfect and sinless life of Jesus Christ?   <br/><input type="radio" id="1429" value="1429" name="15" checked="checked"> <label for="1429"> Yes </label><br />
    <input type="radio" id="1430" value="1430" name="15" checked=""> <label for="1430"> No </label><br />
    <br />Q16. If not please explain.  <br/> <input type="text" name="16" value="Input" size="40" /><br/>
      <br />Q17. Do you believe in the supernatural work in miracles and healing of Jesus Christ?   <br/><input type="radio" id="1432" value="1432" name="17" checked="checked"> <label for="1432"> Yes </label><br />
    <input type="radio" id="1433" value="1433" name="17" checked=""> <label for="1433"> No </label><br />
    <br />Q18. If not please explain.  <br/> <input type="text" name="18" value="Input" size="40" /><br/>
      <br />Q19. . Do you believe in the substitutionary death of Jesus Christ and His bloodshed which atones for sins of the world?   <br/><input type="radio" id="1435" value="1435" name="19" checked="checked"> <label for="1435"> Yes </label><br />
    <input type="radio" id="1436" value="1436" name="19" checked=""> <label for="1436"> No </label><br />
    <br />Q20. If not please explain.  <br/> <input type="text" name="20" value="Input" size="40" /><br/>
      <br />Q21. Do you believe in the personal return of Jesus Christ in power and glory to rapture a mature church?   <br/><input type="radio" id="1438" value="1438" name="21" checked="checked"> <label for="1438"> Yes </label><br />
    <input type="radio" id="1439" value="1439" name="21" checked=""> <label for="1439"> No </label><br />
    <br />Q22. If not please explain.  <br/> <input type="text" name="22" value="Input" size="40" /><br/>
      <br />Q23. Do you believe in the observance of the Eucharist (Holy Communion) and in the ministry and baptism of the Holy Spirit, empowering and enabling the Christian to live a holy life in this present world and to minister as Jesus ministered?   <br/><input type="radio" id="1441" value="1441" name="23" checked="checked"> <label for="1441"> Yes </label><br />
    <input type="radio" id="1442" value="1442" name="23" checked=""> <label for="1442"> No </label><br />
    <br />Q24.  If not please explain.  <br/> <input type="text" name="24" value="Input" size="40" /><br/>
      <br />Q25. Have you been called by God to pastor a church?   <br/><input type="radio" id="1444" value="1444" name="25" checked="checked"> <label for="1444"> Yes </label><br />
    <input type="radio" id="1445" value="1445" name="25" checked=""> <label for="1445"> No </label><br />
    <br />Q26. If yes, did you accept the calling?   <br/><input type="radio" id="1446" value="1446" name="26" checked="checked"> <label for="1446"> Yes </label><br />
    <input type="radio" id="1447" value="1447" name="26" checked=""> <label for="1447"> No </label><br />
    <br />Q27. If not please explain.  <br/> <input type="text" name="27" value="Input" size="40" /><br/>
      <br />Q28. Has your calling been confirmed?    <br/><input type="radio" id="1449" value="1449" name="28" checked="checked"> <label for="1449"> Yes </label><br />
    <input type="radio" id="1450" value="1450" name="28" checked=""> <label for="1450"> No </label><br />
    <br />Q29. If, so by whom and when?  <br/> <input type="text" name="29" value="Bishop Bronner" size="40" /><br/>
      <br />Q30. Are you certified, licensed and/or ordained as a Minister of the Gospel?  <br/><input type="radio" id="1452" value="1452" name="30" checked="checked"> <label for="1452"> Yes </label><br />
    <input type="radio" id="1453" value="1453" name="30" checked=""> <label for="1453"> No </label><br />
    <br />Q31. If, so by whom?  <br/> <input type="text" name="31" value="Input" size="40" /><br/>
      <br />Q32.  Of the stages below, where do you currently consider yourself in the church planting process? (Please select one choice)  <br/><input type="radio" id="1455" value="1455" name="32" checked=""> <label for="1455"> (A) VISION STAGE: I feel called to plant a church but feel that it will be more than 18-24 months from now. </label><br />
    <input type="radio" id="1456" value="1456" name="32" checked="checked"> <label for="1456"> B) PLANNING STAGE: I have begun to move forward in my plans to plant by establishing prayer support, recruiting people to help me plant, raising funds, creating marketing strategy/tools, researching demographics, identifying potential locations, establishing operating budget, etc. </label><br />
    <input type="radio" id="1457" value="1457" name="32" checked=""> <label for="1457"> (C) APPROACHING LAUNCH STAGE: I have a gathering of adults who are committed for 6- 12 months to my church plant and are being trained, dedicated funds are set aside, finalized marketing plan, identified possible locations, finalized operating budget, planned test-launch services, etc. </label><br />
    <input type="radio" id="1458" value="1458" name="32" checked=""> <label for="1458"> (D) PREPARED TO LAUNCH STAGE: I have 50+ ministry launch team members and we are moving forward publicly launching our church plant. I have also executed my marketing plan and operating budget, purchased equipment, signed a lease for the church location, conducted test-launch services, etc. </label><br />
    <br />Q33. Why do you want to plant a church?  <br/> <input type="text" name="33" value="Because of a call on my life.  " size="40" /><br/>
      <br />Q34. What is your proposed launch date?  <br/> <input type="text" name="34" value="January 15, 2015" size="40" /><br/>
      <br />Q35. Where do you plan to plant your church?   <br/> <input type="text" name="35" value="Smyrna, GA" size="40" /><br/>
      <br />Q36. How much money have you raised for your launch, so far?    <br/> <input type="text" name="36" value="$50,000" size="40" /><br/>
      <br />Q37. How much is currently available for use today?    <br/> <input type="text" name="37" value="$50,000" size="40" /><br/>
      <br />Q38. Do you have a sending/sponsoring church?   <br/><input type="radio" id="1464" value="1464" name="38" checked="checked"> <label for="1464"> Yes </label><br />
    <input type="radio" id="1465" value="1465" name="38" checked=""> <label for="1465"> No </label><br />
    <br />Q39. If yes, what is the name, city and state of the sending/sponsoring church?  <br/> <input type="text" name="39" value="WOF" size="40" /><br/>
      <br />Q40. May we contact the pastor of your sponsoring church?   <br/><input type="radio" id="1467" value="1467" name="40" checked="checked"> <label for="1467"> Yes </label><br />
    <input type="radio" id="1468" value="1468" name="40" checked=""> <label for="1468"> No </label><br />
    <br />Q41. Please provide contact information of sending/sponsoring church representative including name, address and phone number.  <br/> <input type="text" name="41" value="Bishop Bronner" size="40" /><br/>
      <br />Q42. Will this be your first church plant experience?   <br/><input type="radio" id="1470" value="1470" name="42" checked="checked"> <label for="1470"> Yes </label><br />
    <input type="radio" id="1471" value="1471" name="42" checked=""> <label for="1471"> No </label><br />
    <br />Q43. If not please explain.  <br/> <input type="text" name="43" value="Input" size="40" /><br/>
      <br />Q44. Who in a church leadership position has endorsed your readiness for this church plant?   <br/> <input type="text" name="44" value="Bishop Bronner" size="40" /><br/>
      <br />Q45. What is your relationship with this leader?  <br/> <input type="text" name="45" value="Spiritual Overcight" size="40" /><br/>
      <br />Q46. Please provide his/her contact information including name, title, address and phone number.  <br/>
                    <textarea rows="3" name="46" cols="50" style="margin-right: 40px; vertical-align: middle;">Input</textarea>
        <br /><br />Q47. Have you received the Baptism of the Holy Spirit?  <br/><input type="radio" id="1571" value="1571" name="47" checked=""> <label for="1571"> Yes </label><br />
    <input type="radio" id="1572" value="1572" name="47" checked=""> <label for="1572"> No </label><br />
    <br />