TravelJoy

Shakea Adams

Kreative Luxe Travel

The Curaçao Escape

<html>
  <body>
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	<fields>&#13;
		<field type="header" subtype="h2" label="Trip Interest&amp;nbsp;"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#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="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="date" required="true" label="Date of Birth" name="date-of-birth" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>