Share your information with Gramille Serrano

Gramille Serrano

Moms at Sea Travel, a Dream Vacations Franchise

<html>
  <body>
    <form-template>&#13;
	<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>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Your phone" name="your-phone" subtype="text" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Not required but please know that sometimes a phone call may be necessary to ensure that we are communicating clearly with our guests and that we understand your needs."/>&#13;
		<field type="radio-group" label="Would you like a phone call? *" name="radio-group-1768781922093">&#13;
			<option label="Yes! As soon as possible! I'm ready to cruise!" value="yes-as-soon-as-possible-im-ready-to-cruise">Yes! As soon as possible! I'm ready to cruise!</option>&#13;
			<option label="Yes, but I'd like to schedule it." value="yes-but-id-like-to-schedule-it">Yes, but I'd like to schedule it.</option>&#13;
			<option label=" Not at this time." value="-not-at-this-time"> Not at this time.</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="Phone requests that are received between 9am and 5pm EST will be accommodated that day. Outside of those hours we will connect with you to hop on a call as soon as we possibly can!"/>&#13;
		<field type="radio-group" label="Would you like us to TEXT you when we sent our initial response? Our emails often get lost in spam and we find this helps you know we have responded to your inquiry" name="radio-group-1768782350640">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Have you previously worked with a Moms at Sea Travel advisor? If so, please let us know who so we may connect you!" name="text-1768782434702" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Do you have any thoughts about your experience you&#39;d like us to know about? Anything on your wish list? *" name="do-you-have-any-thoughts-about-your-experience-youd-like-us-to-know-about-anything-on-your-wish-list-" className="form-control"/>&#13;
		<field type="textarea" label="What ship would you like to sail on?" name="textarea-1768782502280" className="form-control"/>&#13;
		<field type="checkbox-group" label="I don&#39;t know what ship we want but we want these features:" name="checkbox-group-1768782547024">&#13;
			<option label="Florida Port" value="florida-port">Florida Port</option>&#13;
			<option label="New Jersey Port" value="new-jersey-port">New Jersey Port</option>&#13;
			<option label="Galveston Port" value="galveston-port">Galveston Port</option>&#13;
			<option label="Alaska Port" value="alaska-port">Alaska Port</option>&#13;
			<option label="European Port" value="european-port">European Port</option>&#13;
			<option label=" Perfect Day at Coco Cay" value="-perfect-day-at-coco-cay"> Perfect Day at Coco Cay</option>&#13;
			<option label="Waterslides" value="waterslides">Waterslides</option>&#13;
			<option label=" Nursery for children ages 6-36 months" value="-nursery-for-children-ages-636-months"> Nursery for children ages 6-36 months</option>&#13;
			<option label="Adventure Ocean for children over 3" value="adventure-ocean-for-children-over-3">Adventure Ocean for children over 3</option>&#13;
			<option label="Splash Pad for kids in diapers" value="splash-pad-for-kids-in-diapers">Splash Pad for kids in diapers</option>&#13;
		</field>&#13;
		<field type="textarea" label="Sail Date or Range" name="textarea-1768782686700" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="How many guests?" name="checkbox-group-1768782703026">&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6+" value="6">6+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="How many guests 12 and under?" name="checkbox-group-1768782745804">&#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" value="4">4</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What type of Cabin?" name="checkbox-group-1768782779191">&#13;
			<option label="Interior " value="interior-">Interior </option>&#13;
			<option label="Ocean view" value="ocean-view">Ocean view</option>&#13;
			<option label="Ocean View Balcony" value="ocean-view-balcony">Ocean View Balcony</option>&#13;
			<option label="Junior Suite" value="junior-suite">Junior Suite</option>&#13;
			<option label="Star Class" value="star-class">Star Class</option>&#13;
			<option label="Cabins that hold 5+" value="cabins-that-hold-5">Cabins that hold 5+</option>&#13;
			<option label="Accessible Cabin" value="accessible-cabin">Accessible Cabin</option>&#13;
		</field>&#13;
		<field type="textarea" label="State of Residency. Crown and Anchor Number if you have one:" name="textarea-1768782862395" className="form-control"/>&#13;
		<field type="checkbox-group" label="Eligible Discounts" name="checkbox-group-1768782879827">&#13;
			<option label="Military " value="military-">Military </option>&#13;
			<option label="Law Enforcement " value="law-enforcement-">Law Enforcement </option>&#13;
			<option label="EMT/First Responder" value="emtfirst-responder">EMT/First Responder</option>&#13;
			<option label="Senior" value="senior">Senior</option>&#13;
		</field>&#13;
		<field type="textarea" label="Additional notes" name="textarea-1768782930238" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>