Angelica Rucker - Johnson

Angelica Larell + Co

<html>
  <body>
    <form-template>&#13;
	<fields>&#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="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="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Which trip are you interested in?" description="Check all that apply." name="vibe-preference">&#13;
			<option label="Valentine's Weekend Biloxi" value="valentines-weekend-biloxi">Valentine's Weekend Biloxi</option>&#13;
		</field>&#13;
		<field type="textarea" label="Message to Travel Agent" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>