Share your information with Mona Cecala

Mona Cecala

InJoy Travel, Inc

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#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" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of birth" name="date-1781706014662" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="January 8-13, 2026 (5 nights) Double Occupancy"/>&#13;
		<field type="radio-group" label="Room Category Request" name="radio-group-1781706083785">&#13;
			<option label="Alcoba Ocean View King - $2,195.00 per person" value="alcoba-ocean-view-king-219500-per-person">Alcoba Ocean View King - $2,195.00 per person</option>&#13;
			<option label="Alcoba Ocean Double (2 Queen Beds) - $2,295.00 per person" value="alcoba-ocean-double-2-queen-beds-229500-per-person">Alcoba Ocean Double (2 Queen Beds) - $2,295.00 per person</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="January 8-12, 2026 (4 nights) Double Occupancy"/>&#13;
		<field type="radio-group" label="Room Category Request" name="radio-group-1781709805915">&#13;
			<option label="Alcoba Ocean View King - $1,895.00 per person" value="alcoba-ocean-view-king-189500-per-person">Alcoba Ocean View King - $1,895.00 per person</option>&#13;
			<option label="Alcoba Ocean Double (2 Queen Beds) - $1,959.00 per person " value="alcoba-ocean-double-2-queen-beds-195900-per-person-">Alcoba Ocean Double (2 Queen Beds) - $1,959.00 per person </option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Single occupancy prices available upon request."/>&#13;
		<field type="header" subtype="h1" label="Not Included: Roundtrip Airport Transfers, Travel Protection, Optional Tours"/>&#13;
		<field type="header" subtype="h1" label="Roundtrip Airport Transfer Cost:&amp;nbsp;"/>&#13;
		<field type="paragraph" subtype="p" label="$75 per person (4 passengers)"/>&#13;
		<field type="paragraph" subtype="p" label="$45 per person (6 passengers)"/>&#13;
		<field type="paragraph" subtype="p" label="$65 per person (7 passengers)"/>&#13;
		<field type="paragraph" subtype="p" label="$60 per person (8 passengers)"/>&#13;
		<field type="header" subtype="h1" label="Transfers - Your flights must be the same as those of your traveling companions. A quote will be provided at time of booking for 1-3 passengers."/>&#13;
		<field type="text" label="Sharing a room? Provide name, email and phone number of roommate/s" name="text-1781706130446" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Do you have any dietary restrictions?" name="text-1781706192749" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Is there anything else you would like us to know?" name="textarea-1781706218131" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>