Share your information with Vanessa Hart

Vanessa Hart

Moms At Sea Travel, a Dream Vacations Franchise

<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="checkbox-group" label="Would you like a phone call or text?" name="would-you-like-a-phone-call-or-text">&#13;
			<option label="Phone Call" value="phone-call">Phone Call</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Email Only" value="email-only">Email Only</option>&#13;
		</field>&#13;
		<field type="select" label="Would you like a TEXT when I have sent my initial response? My emails often get lost in spam and I find this helps you when I have responded to your inquiry.&amp;nbsp;" name="would-you-like-a-text-when-i-have-sent-my-initial-response-my-emails-often-get-lost-in-spam-and-i-find-this-helps-you-when-i-have-responded-to-your-inquiry-" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Option 3" value="option-3">Option 3</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many travelers total? Any children? If so, what are their ages?*" name="how-many-travelers-total-any-children-if-so-what-are-their-ages" subtype="text" className="form-control"/>&#13;
		<field type="text" label="When would you like to sail?" name="when-would-you-like-to-sail" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What is your preferred departure port?" name="what-is-your-preferred-departure-port" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="I want these features!" name="i-want-these-features">&#13;
			<option label="Perfect day at Cococay!" value="perfect-day-at-cococay">Perfect day at Cococay!</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="Splash Pad" value="splash-pad">Splash Pad</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;
			<option label="Waterslides" value="waterslides">Waterslides</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Cabin Type Preference:" inline="true" name="cabin-type-preference">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Cabins that accommodate 5+" value="cabins-that-accommodate-5">Cabins that accommodate 5+</option>&#13;
			<option label="Connecting Cabins" value="connecting-cabins">Connecting Cabins</option>&#13;
			<option label="Accessible Cabin" value="accessible-cabin">Accessible Cabin</option>&#13;
		</field>&#13;
		<field type="text" label="State of Residency and any appropriate cruise loyalty numbers" name="state-of-residency-and-any-appropriate-cruise-loyalty-numbers" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Eligible Discounts&amp;nbsp;" name="eligible-discounts-">&#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 (55+)" value="senior-55">Senior (55+)</option>&#13;
		</field>&#13;
		<field type="textarea" label="Any other details that you wish to share? Anything else on your wishlist?" name="any-other-details-that-you-wish-to-share-anything-else-on-your-wishlist" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>