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<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Portugal 2026&amp;nbsp;"/>&#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="Middle name" name="middle-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 type="header" subtype="h2" label="Birthdate"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" 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="Cell Phone" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Info"/>&#13;
		<field type="text" required="true" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="text" required="true" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Nationality" name="nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Accommodations" inline="true" name="accommodations">&#13;
			<option label="Single- 1 bed" value="single-1-bed">Single- 1 bed</option>&#13;
			<option label="Double- 2 beds" value="double-2-beds">Double- 2 beds</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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