Share your information with Educational Encounters

Educational Encounters

Educational Encounters with Travelmation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Educational Encounters Trip Registration"/>&#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" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Supervisor Name" name="supervisor-name" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Have you completed the Groups Certification?" name="have-you-completed-the-groups-certification" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Group Name" name="group-name" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Tell Us a Little Bit About Your Lead" name="tell-us-a-little-bit-about-your-lead" className="form-control"/>&#13;
		<field type="radio-group" label="What Educational Encounters Tier are you Interested in? (This is not a commitment)" name="what-educational-encounters-tier-are-you-interested-in-this-is-not-a-commitment">&#13;
			<option label="Silver " value="silver-">Silver </option>&#13;
			<option label="Gold" value="gold">Gold</option>&#13;
			<option label="Platinum" value="platinum">Platinum</option>&#13;
			<option label="I want to learn more about the tiers" value="i-want-to-learn-more-about-the-tiers">I want to learn more about the tiers</option>&#13;
		</field>&#13;
		<field type="textarea" label="Anything else we need to know?&amp;nbsp;" name="anything-else-we-need-to-know-" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>