Share your information with Maria LaDuca

Maria LaDuca

The Agency Chic - Pocono

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Group Leader"/>&#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="Preferred name" name="preferred-name" 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="Mobile number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Preferred Contact Method:" name="preferred-contact-method">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Call" value="call">Call</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="High School Name:" name="high-school-name" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Graduation Year" name="graduation-year">&#13;
			<option label="2026" value="2026">2026</option>&#13;
			<option label="2027" value="2027">2027</option>&#13;
			<option label="2028" value="2028">2028</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Preferred Sailing Dates:" name="preferred-sailing-dates" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Preferred Cruise Length" name="preferred-cruise-length">&#13;
			<option label="3-4 Nights" value="34-nights">3-4 Nights</option>&#13;
			<option label="5-7 Nights" value="57-nights">5-7 Nights</option>&#13;
			<option label="8 Nights +" value="8-nights-">8 Nights +</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Departure Port Preference:" description="What city do you want to cruise from?" name="departure-port-preference" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Preferred Cruise Line(s):" name="preferred-cruise-lines" other="true">&#13;
			<option label="No Preference" value="no-preference">No Preference</option>&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Norwegian Cruise Lines" value="norwegian-cruise-lines">Norwegian Cruise Lines</option>&#13;
			<option label="Carnival" value="carnival">Carnival</option>&#13;
			<option label="MSC" value="msc">MSC</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Cabin Type(s) Interested In:" name="cabin-types-interested-in">&#13;
			<option label="Interior (No Window)" value="interior-no-window">Interior (No Window)</option>&#13;
			<option label="Ocean View (Window)" value="ocean-view-window">Ocean View (Window)</option>&#13;
			<option label="Ocean View Balcony" value="ocean-view-balcony">Ocean View Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Estimated Number of Cabins Needed:" name="estimated-number-of-cabins-needed">&#13;
			<option label="1-4" value="14">1-4</option>&#13;
			<option label="5-9" value="59">5-9</option>&#13;
			<option label="10+ (qualifies for group perks &amp; scholarship program)" value="10-qualifies-for-group-perks-scholarship-program">10+ (qualifies for group perks &amp; scholarship program)</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Are you interested in our Graduation Scholarship Program?" name="are-you-interested-in-our-graduation-scholarship-program">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="How did you hear about us?" name="how-did-you-hear-about-us" className="form-control"/>&#13;
		<field type="text" label="Already working with an agent on our team? List them here so they can reach out to you." name="already-working-with-an-agent-on-our-team-list-them-here-so-they-can-reach-out-to-you" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>