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Salina Curtis

Couture Reservations

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		<field type="header" subtype="h2" label="Full name"/>&#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" 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="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="date" label="Wedding anniversary" name="wedding-anniversary" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Which Cruise(s) are you interested in?" name="checkbox-group-1772223874302">&#13;
			<option label="Carnival -5 Days / 4 Nights The Bahamas from Port Canaveral (Orlando) on the Carnival Freedom" value="carnival-5-days-4-nights-the-bahamas-from-port-canaveral-orlando-on-the-carnival-freedom">Carnival -5 Days / 4 Nights The Bahamas from Port Canaveral (Orlando) on the Carnival Freedom</option>&#13;
			<option label="Carnival - 4 Days / 3 Nights The Bahamas from Miami on the Carnival Sunrise" value="carnival-4-days-3-nights-the-bahamas-from-miami-on-the-carnival-sunrise">Carnival - 4 Days / 3 Nights The Bahamas from Miami on the Carnival Sunrise</option>&#13;
			<option label="MSC Cruises - 9 Days / 8 Nights Eastern Caribbean  on the MSC Meraviglia" value="msc-cruises-9-days-8-nights-eastern-caribbean-on-the-msc-meraviglia">MSC Cruises - 9 Days / 8 Nights Eastern Caribbean  on the MSC Meraviglia</option>&#13;
			<option label="Virgin Voyages - 5 days / 4 nights Key West &amp; Bimini: Valentine’s Voyage on the Scarlet Lady" value="virgin-voyages-5-days-4-nights-key-west-bimini-valentines-voyage-on-the-scarlet-lady">Virgin Voyages - 5 days / 4 nights Key West &amp; Bimini: Valentine’s Voyage on the Scarlet Lady</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
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