Shanelle Lomakema

Sharpe Travel Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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="radio-group" required="true" label="Preferred Method of Contact" name="preferred-method-of-contact">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Text Message" value="text-message">Text Message</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Where are you interested in traveling?" name="where-are-you-interested-in-traveling">&#13;
			<option label="Disneyland " value="disneyland-">Disneyland </option>&#13;
			<option label="Walt Disney World " value="walt-disney-world-">Walt Disney World </option>&#13;
			<option label="Disney Cruises" value="disney-cruises">Disney Cruises</option>&#13;
			<option label="Disney Aulani" value="disney-aulani">Disney Aulani</option>&#13;
			<option label="Universal Hollywood" value="universal-hollywood">Universal Hollywood</option>&#13;
			<option label="Universal Orlando " value="universal-orlando-">Universal Orlando </option>&#13;
			<option label="Adventures by Disney " value="adventures-by-disney-">Adventures by Disney </option>&#13;
		</field>&#13;
		<field type="date" label="Arrival Date" name="arrival-date" className="form-control"/>&#13;
		<field type="date" label="Departure Date" name="departure-date" className="form-control"/>&#13;
		<field type="select" label="How many adults?" name="how-many-adults" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4 or more" value="4-or-more">4 or more</option>&#13;
		</field>&#13;
		<field type="select" label="How many children?" name="how-many-children" className="form-control">&#13;
			<option label="0" value="0">0</option>&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3 or more" value="3-or-more">3 or more</option>&#13;
		</field>&#13;
		<field type="text" label="For children traveling, please include their age at time of travel" name="for-children-traveling-please-include-their-age-at-time-of-travel" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Do any of these apply to you?" name="do-any-of-these-apply-to-you">&#13;
			<option label="Passholder" value="passholder">Passholder</option>&#13;
			<option label="Military " value="military-">Military </option>&#13;
			<option label="Disney Visa Cardholder " value="disney-visa-cardholder-">Disney Visa Cardholder </option>&#13;
		</field>&#13;
		<field type="textarea" label="Please list any other information or important detail to consider (i.e budget, preferences, celebrations, how many park days)" placeholder="Example: My budget is $4 000. I am celebrating my birthday. I want to 2 day park tickets." name="please-list-any-other-information-or-important-detail-to-consider-ie-budget-preferences-celebrations" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>