TravelJoy

Enchanted Ladies Cruises & Tours Travel Agency

Enchanted Ladies Cruises & Tours

ELCT Interest Form

Matteson, IL 60443

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="ELCT Interest Form"/>&#13;
		<field type="header" subtype="h2" label="Full Legal Name"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Main Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Travel Agent"/>&#13;
		<field type="radio-group" required="true" label="Please select your Travel Consultant" inline="true" name="travel-consultant">&#13;
			<option label="Carol Gage" value="carol-gage">Carol Gage</option>&#13;
			<option label="Yolanda Williams" value="yolanda-williams">Yolanda Williams</option>&#13;
			<option label="Brittney Williams" value="brittney-williams">Brittney Williams</option>&#13;
			<option label="Renee Felker" value="renee-felker">Renee Felker</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What type of trip are you interested in booking?" inline="true" name="what-type-of-trip-are-you-interested-in-booking" other="true">&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Land" value="land">Land</option>&#13;
			<option label="Luxury Tours" value="luxury-tours">Luxury Tours</option>&#13;
			<option label="Cruise Group Booking" value="cruise-group-booking">Cruise Group Booking</option>&#13;
			<option label="Land Group Booking" value="land-group-booking">Land Group Booking</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>