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France Fischer Area

Voilà Travel Service

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Guest 1 Information"/>&#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" 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="date" required="true" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="text" required="true" label="Country of Citizenship" name="text-1751066309708" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" 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="header" subtype="h2" label="Cruise Details"/>&#13;
		<field type="checkbox-group" required="true" label="Pease send me a Quote for the Following Cabins&amp;nbsp;" name="pease-send-me-a-quote-for-the-following-cabins-" other="true">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Interior Central Park View" value="interior-central-park-view">Interior Central Park View</option>&#13;
			<option label="Ocean View" value="ocean-view">Ocean View</option>&#13;
			<option label="Central Park Balcony" value="central-park-balcony">Central Park Balcony</option>&#13;
			<option label="Boardwalk Balcony" value="boardwalk-balcony">Boardwalk Balcony</option>&#13;
			<option label="Ocean View Balcony" value="ocean-view-balcony">Ocean View Balcony</option>&#13;
			<option label="Jr Suite" value="jr-suite">Jr Suite</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" label="Special requests: # people or other request" name="text-1767473613321" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Dinner Choice" name="radio-group-1767472944052">&#13;
			<option label="5:00" value="500">5:00</option>&#13;
			<option label="7:30" value="730">7:30</option>&#13;
			<option label="8:30" value="830">8:30</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Bed Choice" name="radio-group-1751737360578">&#13;
			<option label="together" value="together">together</option>&#13;
			<option label="apart" value="apart">apart</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Need Pre/Post Cruise Hotel room?" name="radio-group-1751737517217" other="true">&#13;
			<option label="Yes! Please send me info" value="yes-please-send-me-info">Yes! Please send me info</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Insurance" name="radio-group-1760980804683" other="true">&#13;
			<option label="Yes! Please send me info" value="yes-please-send-me-info">Yes! Please send me info</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="ABA CON Registration Information"/>&#13;
		<field type="radio-group" required="true" label="Certification" name="certification">&#13;
			<option label="BCBA" value="bcba">BCBA</option>&#13;
			<option label="RBT" value="rbt">RBT</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
			<option label="Non Participant" value="non-participant">Non Participant</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="BACB Certification Number and Expiration" name="bacb-certification-number-and-expiration" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Additional Participants names and BACB Certification Numbers and Expirations" name="text-1760980745311" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How did you hear about us?" name="how-did-you-hear-about-us" other="true">&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Tik Tok" value="tik-tok">Tik Tok</option>&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Referral" value="referral">Referral</option>&#13;
		</field>&#13;
		<field type="text" label="Referral Code/Name" name="referral-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Guest 2 Information for Reservation"/>&#13;
		<field type="text" label="Guest 2: First Name" name="text-1767472436700" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Guest 2: Last Name" name="text-1767472469784" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Guest 2: Primary Email" name="text-1767472502307" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Guest 2: Primary Phone Number" name="text-1767472529512" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Guest 2: Country of Citizenship" name="text-1767472633376" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Guest 2: DOB" name="date-1767472548094" className="form-control"/>&#13;
		<field type="radio-group" label="Guest 2: Gender" name="radio-group-1767472576348">&#13;
			<option label="M" value="m">M</option>&#13;
			<option label="F" value="f">F</option>&#13;
			<option label="X" value="x">X</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Emergency Contact Information"/>&#13;
		<field type="text" label="Full name" name="emergency-contact-full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="emergency-contact-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Relationship to you" name="emergency-contact-relationship" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>