<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Full name"/> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Address"/> <field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="text" label="Country" name="address-country" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="radio-group" label="Where would you like to sail to?" name="where-would-you-like-to-sail-to" other="true"> <option label="Alaska" value="alaska">Alaska</option> <option label=" Asia " value="-asia-"> Asia </option> <option label="Austrailia/New Zealand" value="austrailianew-zealand">Austrailia/New Zealand</option> <option label="Bermuda" value="bermuda">Bermuda</option> <option label="Canada/New England" value="canadanew-england">Canada/New England</option> <option label="Caribbean" value="caribbean">Caribbean</option> <option label="Europe" value="europe">Europe</option> <option label="Hawaii" value="hawaii">Hawaii</option> <option label="Mexico" value="mexico">Mexico</option> <option label="South America" value="south-america">South America</option> <option label="South Pacific" value="south-pacific">South Pacific</option> <option label="The Bahamas" value="the-bahamas">The Bahamas</option> <option label="Transatlantic" value="transatlantic">Transatlantic</option> </field> <field type="text" label="Do you have particular ports you'd like to visit? If so, list here." name="do-you-have-particular-ports-youd-like-to-visit-if-so-list-here" subtype="text" className="form-control"/> <field type="text" required="true" label="Where would you prefer your cruise to leave from?*" name="where-would-you-prefer-your-cruise-to-leave-from" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Would you like airfare included in your proposal?" name="would-you-like-airfare-included-in-your-proposal" other="true"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="If you would like flights, which is your preferred departure airport?" name="if-you-would-like-flights-which-is-your-preferred-departure-airport" subtype="text" className="form-control"/> <field type="text" required="true" label="What are your preferred dates or date range?&nbsp;" name="what-are-your-preferred-dates-or-date-range-" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Are your dates flexible?" name="are-your-dates-flexible"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" required="true" label="How many days would you like to sail? You can select a range." name="how-many-days-would-you-like-to-sail-you-can-select-a-range"> <option label="3 days" value="3-days">3 days</option> <option label="4 days" value="4-days">4 days</option> <option label="5 days" value="5-days">5 days</option> <option label="6 days" value="6-days">6 days</option> <option label="7 days" value="7-days">7 days</option> <option label="8 days" value="8-days">8 days</option> <option label="9 days" value="9-days">9 days</option> <option label="10+ days" value="10-days">10+ days</option> </field> <field type="checkbox-group" required="true" label="Do you have a preferred cruise line? If so, check all that apply." name="do-you-have-a-preferred-cruise-line-if-so-check-all-that-apply" other="true"> <option label="Azamara" value="azamara">Azamara</option> <option label=" Carnival" value="-carnival"> Carnival</option> <option label=" Celebrity" value="-celebrity"> Celebrity</option> <option label=" Disney " value="-disney-"> Disney </option> <option label=" Norwegian" value="-norwegian"> Norwegian</option> <option label=" Princess " value="-princess-"> Princess </option> <option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option> <option label=" Viking River Cruise" value="-viking-river-cruise"> Viking River Cruise</option> <option label="Virgin-Adults Only" value="virginadults-only">Virgin-Adults Only</option> </field> <field type="text" label="Do you participate in any loyalty programs? If so, list which ones here." name="do-you-participate-in-any-loyalty-programs-if-so-list-which-ones-here" subtype="text" className="form-control"/> <field type="checkbox-group" label="Does anyone in your group apply for the following?" inline="true" name="does-anyone-in-your-group-apply-for-the-following"> <option label="Age 55+Fire Department" value="age-55fire-department">Age 55+Fire Department</option> <option label="US or Canadian Law Enforcement" value="us-or-canadian-law-enforcement">US or Canadian Law Enforcement</option> <option label=" Fire Department or EMT" value="-fire-department-or-emt"> Fire Department or EMT</option> <option label="US Military or Canadian Forces" value="us-military-or-canadian-forces">US Military or Canadian Forces</option> </field> <field type="radio-group" required="true" label="How many staterooms do you need?&nbsp;" name="how-many-staterooms-do-you-need-" other="true"> <option label="1" value="1">1</option> <option label="2" value="2">2</option> <option label="3" value="3">3</option> </field> <field type="header" subtype="h1" label="Stateroom 1"/> <field type="text" required="true" label="Ages of guests in Stateroom 1:" name="ages-of-guests-in-stateroom-1" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Stateroom 1 Category Preference" name="stateroom-1-category-preference"> <option label="Inside Cabin" value="inside-cabin">Inside Cabin</option> <option label=" Ocean View Cabin" value="-ocean-view-cabin"> Ocean View Cabin</option> <option label=" Balcony View Cabin" value="-balcony-view-cabin"> Balcony View Cabin</option> <option label=" Extended Balcony Cabin (If available)" value="-extended-balcony-cabin-if-available"> Extended Balcony Cabin (If available)</option> <option label=" Suite Balcony Cabin" value="-suite-balcony-cabin"> Suite Balcony Cabin</option> </field> <field type="header" subtype="h1" label="Stateroom 2"/> <field type="text" label="Ages of guests in Stateroom 2:" name="ages-of-guests-in-stateroom-2" subtype="text" className="form-control"/> <field type="radio-group" label="Stateroom 2 Category Preference" name="stateroom-2-category-preference"> <option label="Inside Cabin" value="inside-cabin">Inside Cabin</option> <option label=" Ocean View Cabin" value="-ocean-view-cabin"> Ocean View Cabin</option> <option label=" Balcony View Cabin" value="-balcony-view-cabin"> Balcony View Cabin</option> <option label=" Extended Balcony Cabin (If available)" value="-extended-balcony-cabin-if-available"> Extended Balcony Cabin (If available)</option> <option label=" Suite Balcony Cabin" value="-suite-balcony-cabin"> Suite Balcony Cabin</option> </field> <field type="header" subtype="h1" label="Stateroom 3"/> <field type="text" label="Ages of guests in Stateroom 3:" name="ages-of-guests-in-stateroom-3" subtype="text" className="form-control"/> <field type="radio-group" label="Stateroom 3 Category Preference" name="stateroom-3-category-preference"> <option label="Inside Cabin" value="inside-cabin">Inside Cabin</option> <option label=" Ocean View Cabin" value="-ocean-view-cabin"> Ocean View Cabin</option> <option label=" Balcony View Cabin" value="-balcony-view-cabin"> Balcony View Cabin</option> <option label=" Extended Balcony Cabin (If available)" value="-extended-balcony-cabin-if-available"> Extended Balcony Cabin (If available)</option> <option label=" Suite Balcony Cabin" value="-suite-balcony-cabin"> Suite Balcony Cabin</option> </field> <field type="checkbox-group" required="true" label="Which activities are you interested in?" inline="true" name="which-activities-are-you-interested-in" other="true"> <option label=" Beach" value="-beach"> Beach</option> <option label=" Ocean/Water" value="-oceanwater"> Ocean/Water</option> <option label=" Food/Wine" value="-foodwine"> Food/Wine</option> <option label=" Sports/Active" value="-sportsactive"> Sports/Active</option> <option label=" Bus Tour" value="-bus-tour"> Bus Tour</option> <option label=" Wildlife Culture/History " value="-wildlife-culturehistory-"> Wildlife Culture/History </option> <option label="Family Friendly " value="family-friendly-">Family Friendly </option> <option label="Gambling " value="gambling-">Gambling </option> <option label="Golf " value="golf-">Golf </option> </field> <field type="textarea" label="Please list any upgrades you would like? For example, beverage package, specialty dining, etc." name="please-list-any-upgrades-you-would-like-for-example-beverage-package-specialty-dining-etc" className="form-control"/> <field type="radio-group" label="Is your trip a special occasion?&nbsp;" name="is-your-trip-a-special-occasion-" other="true"> <option label="Honeymoon " value="honeymoon-">Honeymoon </option> <option label="Anniversary" value="anniversary">Anniversary</option> <option label=" Birthday" value="-birthday"> Birthday</option> </field> <field type="textarea" required="true" label="Are you able to fly a day or two prior to embarkation?&nbsp;" name="are-you-able-to-fly-a-day-or-two-prior-to-embarkation-" className="form-control"/> <field type="textarea" required="true" label="What are you most looking forward to about your trip?" name="what-are-you-most-looking-forward-to-about-your-trip" className="form-control"/> <field type="textarea" label="Anything else you'd like me to know? Be specific as possible." name="anything-else-youd-like-me-to-know-be-specific-as-possible" className="form-control"/> <field type="radio-group" label="Would you be ready to make the deposit for your vacation if I found sailings that matched what you've listed above?" name="would-you-be-ready-to-make-the-deposit-for-your-vacation-if-i-found-sailings-that-matched-what-youve-listed-above"> <option label="Yes" value="yes">Yes</option> <option label="We are just exploring our options" value="we-are-just-exploring-our-options">We are just exploring our options</option> <option label="No" value="no">No</option> </field> <field type="radio-group" label="What budget range would you like to stick to for this vacation?&nbsp;" name="what-budget-range-would-you-like-to-stick-to-for-this-vacation-"> <option label="$0-1,000" value="01000">$0-1,000</option> <option label=" $1,000-2,000" value="-10002000"> $1,000-2,000</option> <option label="$2,000-3,000" value="20003000">$2,000-3,000</option> <option label="$3,000-4,000" value="30004000">$3,000-4,000</option> <option label="$4,000-5,000" value="40005000">$4,000-5,000</option> <option label="$5,000-6,000" value="50006000">$5,000-6,000</option> <option label="$6,000-7,000" value="60007000">$6,000-7,000</option> <option label="$7,000-8,000" value="70008000">$7,000-8,000</option> <option label="$8,000-9,000" value="80009000">$8,000-9,000</option> <option label="$9,000-10,000" value="900010000">$9,000-10,000</option> </field> <field type="text" label="How Did You Hear About Luxury and Adventure Travels?" name="how-did-you-hear-about-luxury-and-adventure-travels" subtype="text" className="form-control"/> </fields> </form-template> </body> </html>
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