Share your information with Melissa rosen

Melissa rosen

Roam with Rosen

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Intake Form"/>&#13;
		<field type="paragraph" subtype="p" label="Provide some quick info and we will reach out right away to help you plan your next voyage!"/>&#13;
		<field type="text" required="true" label="First Name" description="Please enter your first name." placeholder="Type your response..." name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last Name" description="Please enter your last name." placeholder="Type your response..." name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" subtype="tel" label="Mobile Phone" placeholder="Type a phone number.." name="phone-number" className="form-control"/>&#13;
		<field required="true"  type="text" subtype="email" label="Email" placeholder="Type an email..." name="email" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How did you hear about Roam with Rosen?" description="Please choose only one option." name="hear-about-roam-with-rosen">&#13;
			<option label="Linked In" value="Linked In">Linked In</option>&#13;
			<option label="What's App Group" value="What's App Group">What's App Group</option>&#13;
			<option label="Friend/Referral " value="Friend/Referral ">Friend/Referral </option>&#13;
			<option label="Website" value="Website">Website</option>&#13;
			<option label="Sailing Sisters Webinar" value="Sailing Sisters Webinar">Sailing Sisters Webinar</option>&#13;
			<option label="Event" value="Event">Event</option>&#13;
			<option label="Email Marketing" value="email-marketing">Email Marketing</option>&#13;
			<option label="Event/In Person" value="eventin-person">Event/In Person</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What are you most interested in right now?" description="Please select all that apply." inline="true" name="interested-in-right-now">&#13;
			<option label="Cruise deals &amp; price drops" value="Cruise deals &amp; price drops">Cruise deals &amp; price drops</option>&#13;
			<option label="Host a Group" value="host-a-group">Host a Group</option>&#13;
			<option label="Luxury or expedition cruises" value="Luxury or expedition cruises">Luxury or expedition cruises</option>&#13;
			<option label="Custom cruise planning (concierge support)" value="Custom cruise planning (concierge support)">Custom cruise planning (concierge support)</option>&#13;
			<option label="Just browsing / future travel" value="Just browsing / future travel">Just browsing / future travel</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="“I agree to receive cruise updates and planning communication from Roam with Rosen.”" description="Please choose only one option." name="agree-to-receive-cruise-updates">&#13;
			<option label="Yes" value="Yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>