TravelJoy

Laquietta T.

Quality Travel & Adventure

Melia Wellness

Punta Cana

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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="date" required="true" label="Date of Birth" name="date-of-birth" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Preferred Method of Contact?" name="preferred-method-of-contact" className="form-control">&#13;
			<option label="Phone" value="phone" selected="selected">Phone</option>&#13;
			<option label="Email" value="email">Email</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What are you dates of travel?&amp;nbsp;" name="what-are-you-dates-of-travel-" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
			<option label="X" value="other">X</option>&#13;
		</field>&#13;
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>