<form-template>
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>
		<field type="date" required="true" label="George/Lewis Wedding - Please select your arrival date." name="travel-dates-if-different-" className="form-control"/>
		<field type="paragraph" subtype="p" label="Prices are per person and includes all inclusive hotel accommodations and roundtrip airport transfers to and from the resort.                                                                                                      "/>
		<field type="paragraph" subtype="p" label="Please Select Room Category.  If none select NONE."/>
		<field type="select" required="true" label="Jr Suite Ocean View&amp;nbsp;&amp;nbsp;" name="jr-suite-pool-view-please-select-room-category-prices-are-per-person-and-includes-all-inclusive-hotel-accommodations-and-roundtrip-airport-transfers-to-and-from-the-resort" className="form-control">
			<option label="4 nights - Single - $1120 per person" value="4-nights-single-1120-per-person" selected="true">4 nights - Single - $1120 per person</option>
			<option label="4 nights - Double - $756 per person" value="4-nights-double-756-per-person">4 nights - Double - $756 per person</option>
			<option label="4 nights - Triple - $696 per person" value="4-nights-triple-696-per-person">4 nights - Triple - $696 per person</option>
			<option label="4 nights - Child - $392 per child 2-12 years old" value="4-nights-child-392-per-child-212-years-old">4 nights - Child - $392 per child 2-12 years old</option>
			<option label="4 nights - Child - $574 per child 13-17 years old" value="4-nights-child-574-per-child-1317-years-old">4 nights - Child - $574 per child 13-17 years old</option>
			<option label="5 nights - Single - $1393 per person" value="5-nights-single-1393-per-person">5 nights - Single - $1393 per person</option>
			<option label="5 nights - Double - $938 per person" value="5-nights-double-938-per-person">5 nights - Double - $938 per person</option>
			<option label="5 nights - Triple - $863 per person" value="5-nights-triple-863-per-person">5 nights - Triple - $863 per person</option>
			<option label="5 nights - Child - $483 per child 2-12 years old" value="5-nights-child-483-per-child-212-years-old">5 nights - Child - $483 per child 2-12 years old</option>
			<option label="5 nights - Child - $713 per child 13-17 years old" value="5-nights-child-713-per-child-1317-years-old">5 nights - Child - $713 per child 13-17 years old</option>
			<option label="6 nights - Single - $1666 per person" value="6-nights-single-1666-per-person">6 nights - Single - $1666 per person</option>
			<option label="6 nights - Double - $1120 per person" value="6-nights-double-1120-per-person">6 nights - Double - $1120 per person</option>
			<option label="6 nights - Triple - $1030 per person" value="6-nights-triple-1030-per-person">6 nights - Triple - $1030 per person</option>
			<option label="6 nights - Child - $574 per child 2-12 years old" value="6-nights-child-574-per-child-212-years-old">6 nights - Child - $574 per child 2-12 years old</option>
			<option label="6 nights - Child - $850 per child 13-17 years old" value="6-nights-child-850-per-child-1317-years-old">6 nights - Child - $850 per child 13-17 years old</option>
			<option label="7 nights - Single - $1939 per person" value="7-nights-single-1939-per-person">7 nights - Single - $1939 per person</option>
			<option label="7 nights - Double - $1302 per person" value="7-nights-double-1302-per-person">7 nights - Double - $1302 per person</option>
			<option label="7 nights - Triple - $1197 per person " value="7-nights-triple-1197-per-person-">7 nights - Triple - $1197 per person </option>
			<option label="7 nights - Child - $665 per child 2-12 years old" value="7-nights-child-665-per-child-212-years-old">7 nights - Child - $665 per child 2-12 years old</option>
			<option label="7 nights - Child - $987 per child 13-17 years old" value="7-nights-child-987-per-child-1317-years-old">7 nights - Child - $987 per child 13-17 years old</option>
			<option label="NONE" value="NONE">NONE</option>
		</field>
		<field type="select" required="true" label="Jr Suite Beachfront" name="jr-suite-garden-view-please-select-room-category-prices-are-per-person-and-includes-all-inclusive-hotel-accommodations-and-roundtrip-airport-transfers-to-and-from-the-resort" className="form-control">
			<option label="4 nights - Single - $1128 per person" value="4-nights-single-1128-per-person" selected="true">4 nights - Single - $1128 per person</option>
			<option label="4 nights - Double - $764 per person" value="4-nights-double-764-per-person">4 nights - Double - $764 per person</option>
			<option label="4 nights - Child - $396 per child 2-12 years old" value="4-nights-child-396-per-child-212-years-old">4 nights - Child - $396 per child 2-12 years old</option>
			<option label="4 nights - Child - $580 per child 13-17 years old" value="4-nights-child-580-per-child-1317-years-old">4 nights - Child - $580 per child 13-17 years old</option>
			<option label="5 nights - Single - $1403 per person" value="5-nights-single-1403-per-person">5 nights - Single - $1403 per person</option>
			<option label="5 nights - Double - $948 per person" value="5-nights-double-948-per-person">5 nights - Double - $948 per person</option>
			<option label="5 nights - Triple - $873 per person" value="5-nights-triple-873-per-person">5 nights - Triple - $873 per person</option>
			<option label="5 nights - Child - $488 per child 2-12 years old" value="5-nights-child-488-per-child-212-years-old">5 nights - Child - $488 per child 2-12 years old</option>
			<option label="5 nights - Child - $718 per child 13-17 years old" value="5-nights-child-718-per-child-1317-years-old">5 nights - Child - $718 per child 13-17 years old</option>
			<option label="6 nights - Single - $1678 per person" value="6-nights-single-1678-per-person">6 nights - Single - $1678 per person</option>
			<option label="6 nights - Double - $1132 per person" value="6-nights-double-1132-per-person">6 nights - Double - $1132 per person</option>
			<option label="6 nights - Triple - $1042 per person" value="6-nights-triple-1042-per-person">6 nights - Triple - $1042 per person</option>
			<option label="6 nights - Child - $580 per child 2-12 years old" value="6-nights-child-580-per-child-212-years-old">6 nights - Child - $580 per child 2-12 years old</option>
			<option label="6 nights - Child - $856 per child 13-17 years old" value="6-nights-child-856-per-child-1317-years-old">6 nights - Child - $856 per child 13-17 years old</option>
			<option label="7 nights - Single - $1953 per person" value="7-nights-single-1953-per-person">7 nights - Single - $1953 per person</option>
			<option label="7 nights - Double - $1316 per person" value="7-nights-double-1316-per-person">7 nights - Double - $1316 per person</option>
			<option label="7 nights - Triple - $1211 per person" value="7-nights-triple-1211-per-person">7 nights - Triple - $1211 per person</option>
			<option label="7 nights - Child - $672 per child 2-12 years old" value="7-nights-child-672-per-child-212-years-old">7 nights - Child - $672 per child 2-12 years old</option>
			<option label="7 nights - Child - $994 per child 13-17 years old" value="7-nights-child-994-per-child-1317-years-old">7 nights - Child - $994 per child 13-17 years old</option>
			<option label="NONE" value="NONE">NONE</option>
		</field>
		<field type="select" required="true" label="Jr Suite Beachfront Oceanview" name="suite-jacuzzi-please-select-room-category-prices-are-per-person-and-includes-all-inclusive-hotel-accommodations-and-roundtrip-airport-transfers-to-and-from-the-resort" className="form-control">
			<option label="4 nights - Single - $1168 per person" value="4-nights-single-1168-per-person" selected="true">4 nights - Single - $1168 per person</option>
			<option label="4 nights - Double - $788 per person" value="4-nights-double-788-per-person">4 nights - Double - $788 per person</option>
			<option label="4 nights - Triple - $728 per person" value="4-nights-triple-728-per-person">4 nights - Triple - $728 per person</option>
			<option label="4 nights - Child - $408 per child 2-12 years old" value="4-nights-child-408-per-child-212-years-old">4 nights - Child - $408 per child 2-12 years old</option>
			<option label="4 nights - Child - $600 per child 13-17 years old" value="4-nights-child-600-per-child-1317-years-old">4 nights - Child - $600 per child 13-17 years old</option>
			<option label="5 nights - Single - $1453 per person" value="5-nights-single-1453-per-person">5 nights - Single - $1453 per person</option>
			<option label="5 nights - Double - $978 per person" value="5-nights-double-978-per-person">5 nights - Double - $978 per person</option>
			<option label="5 nights - Triple - $903 per person " value="5-nights-triple-903-per-person-">5 nights - Triple - $903 per person </option>
			<option label="5 nights - Child - $503 per child 2-12 years old" value="5-nights-child-503-per-child-212-years-old">5 nights - Child - $503 per child 2-12 years old</option>
			<option label="5 nights - Child - $743 per child 13-17 years old" value="5-nights-child-743-per-child-1317-years-old">5 nights - Child - $743 per child 13-17 years old</option>
			<option label="6 nights - Child - $743 per child 13-17 years old" value="6-nights-child-743-per-child-1317-years-old">6 nights - Child - $743 per child 13-17 years old</option>
			<option label="6 nights - Double - $1168 per person" value="6-nights-double-1168-per-person">6 nights - Double - $1168 per person</option>
			<option label="6 nights - Triple - $1078 per person " value="6-nights-triple-1078-per-person-">6 nights - Triple - $1078 per person </option>
			<option label="6 nights - Child - $598 per child 2-12 years old" value="6-nights-child-598-per-child-212-years-old">6 nights - Child - $598 per child 2-12 years old</option>
			<option label="6 nights - Child - $886 per child 13-17 years old" value="6-nights-child-886-per-child-1317-years-old">6 nights - Child - $886 per child 13-17 years old</option>
			<option label="7 nights - Single - $2023 per person" value="7-nights-single-2023-per-person">7 nights - Single - $2023 per person</option>
			<option label="7 nights - Double - $1358 per person" value="7-nights-double-1358-per-person">7 nights - Double - $1358 per person</option>
			<option label="7 nights - Triple - $1253 per person " value="7-nights-triple-1253-per-person-">7 nights - Triple - $1253 per person </option>
			<option label="7 nights - Child - $693 per child 2-12 years old" value="7-nights-child-693-per-child-212-years-old">7 nights - Child - $693 per child 2-12 years old</option>
			<option label="7 nights - Child - $1029 per child 13-17 years old" value="7-nights-child-1029-per-child-1317-years-old">7 nights - Child - $1029 per child 13-17 years old</option>
			<option label="NONE" value="NONE">NONE</option>
		</field>
		<field type="select" label="Romance Villa Suite" name="romance-villa-suite" className="form-control">
			<option label="4 nights - Single - $1288 per person" value="4-nights-single-1288-per-person" selected="true">4 nights - Single - $1288 per person</option>
			<option label="4 nights - Double - $868 per person" value="4-nights-double-868-per-person">4 nights - Double - $868 per person</option>
			<option label="5 nights - Single - $1603 per person" value="5-nights-single-1603-per-person">5 nights - Single - $1603 per person</option>
			<option label="5 nights - Double - $1078 per person" value="5-nights-double-1078-per-person">5 nights - Double - $1078 per person</option>
			<option label="6 nights - Single - $1918 per person" value="6-nights-single-1918-per-person">6 nights - Single - $1918 per person</option>
			<option label="6 nights - Double - $1288 per person" value="6-nights-double-1288-per-person">6 nights - Double - $1288 per person</option>
			<option label="7 nights - Single - $2233 per person" value="7-nights-single-2233-per-person">7 nights - Single - $2233 per person</option>
			<option label="7 nights - Double - $1498 per person" value="7-nights-double-1498-per-person">7 nights - Double - $1498 per person</option>
			<option label="NONE" value="NONE">NONE</option>
		</field>
		<field type="radio-group" required="true" label="Do you need airfare?" name="do-you-need-airfare-from-a-different-gateway">
			<option label="Yes" value="yes">Yes</option>
			<option label="No" value="no">No</option>
		</field>
		<field type="text" label="If yes, from what city?" name="if-yes-from-what-gateway-" subtype="text" className="form-control"/>
		<field type="radio-group" required="true" label="Number of rooms" name="number-of-rooms">
			<option label="1" value="1">1</option>
			<option label="2" value="2">2</option>
			<option label="3" value="3">3</option>
			<option label="4" value="4">4</option>
			<option label="5" value="5">5</option>
		</field>
		<field type="radio-group" required="true" label="Number of Guests" name="number-of-guests">
			<option label="1" value="1">1</option>
			<option label="2" value="2">2</option>
			<option label="3" value="3">3</option>
			<option label="4" value="4">4</option>
			<option label="5" value="5">5</option>
		</field>
		<field type="textarea" label="Please provide the names and dates of birth for you and your travelling companions as shown on your passport." name="please-provide-the-guests-names-and-date-of-birth-for-all-guests-in-your-party-as-shown-on-their-passport" className="form-control"/>
		<field type="text" required="true" label="Phone Number" name="phone-number" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Email Address" name="email" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Address" name="address-line-1" subtype="text" className="form-control"/>
		<field type="text" label="Address 2" name="address-line-2" subtype="text" className="form-control"/>
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>
		<field type="radio-group" required="true" label="Best Method of Contact" name="best-method-of-contact">
			<option label="Phone" value="phone">Phone</option>
			<option label="Email" value="email">Email</option>
			<option label="Text" value="text">Text</option>
		</field>
		<field type="radio-group" required="true" label="TRAVEL PROTECTION: Cancel for any reason" name="travel-protection-voucher-back-policy-">
			<option label="Accept" value="accept">Accept</option>
			<option label="Decline" value="decline">Decline</option>
		</field>
		<field type="radio-group" required="true" label="TRAVEL PROTECTION: Cancel for medical reasons" name="travel-protection-cash-back-policy">
			<option label="Accept" value="accept">Accept</option>
			<option label="Decline" value="decline">Decline</option>
		</field>
		<field type="radio-group" required="true" label="Please accept the terms of cancellation by checking the box below." description="CANCELLATION POLICY  From depositing to 98 days prior to arrival deposit  non-refundable.97 - 53 days prior to arrival 1-night hotel penalty per room  based on category 52 - 38 days prior to arrival 2-night penalty per room  based on category cancelled.37 days or less prior to arrival will result in 100% penalty." name="terms-conditions-cancellation-policy">
			<option label="Accept" value="accept" selected="true">Accept</option>
			<option label="Decline" value="decline">Decline</option>
		</field>
		<field type="text" required="true" label="I the undersign have read and understand the cancellation terms and conditions written in the above policy. By signing below, you agree to the Terms and Conditions of this e-STATEMENT Reservation Agreement." name="i-the-undersign-have-read-and-understand-the-cancellation-terms-and-conditions-written-in-the-above-policy-by-signing-below-you-agree-to-the-terms-and-conditions-of-this-estatement-reservation-agreement" subtype="text" className="form-control"/>
	</fields>
</form-template>