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Empeiria Escapes

<html>
  <body>
<form-template>
  <fields>
    <field type="header" subtype="h2" label="Contact Information"/>
    <field type="text" subtype="text" label="Prefix" name="prefix" className="form-control"/>
    <field type="text" subtype="text" required="true" label="First name" name="first-name" className="form-control"/>
    <field type="text" subtype="text" label="Middle name" name="middle-name" className="form-control"/>
    <field type="text" subtype="text" required="true" label="Last name" name="last-name" className="form-control"/>
    <field type="text" subtype="text" label="Suffix" name="suffix" className="form-control"/>
    <field type="text" subtype="text" label="Preferred name (nickname)" name="preferred-name" className="form-control"/>
    <field type="text" subtype="text" required="true" label="Primary email address" name="email" className="form-control"/>
    <field type="text" subtype="text" label="Primary phone number" name="phone-number" className="form-control"/>
    <field type="header" subtype="h2" label="Passport Information"/>
    <field type="text" subtype="text" label="Full name as it appears on passport" name="passport-name" className="form-control"/>
    <field type="text" subtype="text" label="Passport number" name="passport-number" className="form-control"/>
    <field type="text" subtype="text" label="Country of issue" name="passport-country-of-issue" className="form-control"/>
    <field type="date" label="Date of birth" name="birthday" className="form-control"/>
    <field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>
    <field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>
    <field type="radio-group" label="Sex" name="gender">
      <option value="female" label="F">F</option>
      <option value="male" label="M">M</option>
      <option value="other" label="X">X</option>
    </field>
    <field type="header" subtype="h2" label="Travel Preferences"/>
    <field type="radio-group" label="Seat preference" name="seat-preference">
      <option value="window" label="Window">Window</option>
      <option value="aisle" label="Aisle">Aisle</option>
      <option value="opposite aisle" label="Opposite Aisle">Opposite Aisle</option>
    </field>
    <field type="radio-group" label="Bed preference" name="bed-preference">
      <option value="king" label="King">King</option>
      <option value="2-double-queen" label="2 Double/Queen">2 Double/Queen</option>
    </field>
    <field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference">
      <option value="value" label="Economy">Economy</option>
      <option value="moderate" label="Moderate">Moderate</option>
      <option value="luxury" label="Luxury">Luxury</option>
      <option value="boutique" label="Boutique">Boutique</option>
    </field>
    <field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference">
      <option value="romantic" label="Romantic">Romantic</option>
      <option value="rest-and-relaxation" label="Rest and relaxation">Rest and relaxation</option>
      <option value="off-the-beaten-path" label="Off the beaten path">Off the beaten path</option>
      <option value="party" label="Party">Party</option>
      <option value="local-culture" label="Local culture">Local culture</option>
      <option value="family-friendly" label="Family friendly">Family friendly</option>
      <option value="food-wine" label="Food and wine">Food and wine</option>
      <option value="multi-generational" label="Multi-generational">Multi-generational</option>
      <option value="adventure" label="Adventure">Adventure</option>
    </field>
    <field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences">
      <option value="beach-water" label="Beach and water">Beach and water</option>
      <option value="gambling" label="Gambling">Gambling</option>
      <option value="scuba" label="Scuba">Scuba</option>
      <option value="adventure" label="Adventure activities">Adventure activities</option>
      <option value="golf" label="Golf">Golf</option>
      <option value="nightlife" label="Nightlife">Nightlife</option>
      <option value="art-theater" label="Arts and theater">Arts and theater</option>
    </field>
  </fields>
</form-template>
</body>
</html>