Share your information with Patrick & Mandi Emery

Patrick & Mandi Emery

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="paragraph" subtype="p" label="ONE FORM PER PERSON"/>&#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" 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="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="DOES THE NAME ABOVE MATCH YOUR PASSPORT OR&amp;nbsp; LICENSE" description="Passport are required on some cruise but recommended for all cruises  Driver Licenses with Long Form Birth Certficate that the names MATCH can be used on some US Itineraries." name="does-the-name-above-match-your-passport-or-license" className="form-control">&#13;
			<option label="YES, Name matches my passport" value="yes-name-matches-my-passport">YES, Name matches my passport</option>&#13;
			<option label="YES, Name matches my driver license" value="yes-name-matches-my-driver-license">YES, Name matches my driver license</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" 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="radio-group" required="true" label="Bed preference" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Travel Dates:&amp;nbsp;&amp;nbsp;" description="Dates you can travel" name="travel-dates-" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Destination" name="destination" className="form-control">&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Canada" value="canada">Canada</option>&#13;
			<option label="Hawaii" value="hawaii">Hawaii</option>&#13;
			<option label="Panama Canal" value="panama-canal">Panama Canal</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="River Cruise" value="river-cruise">River Cruise</option>&#13;
		</field>&#13;
		<field type="select" label="Cruise Line&amp;nbsp; you would like to travel with" name="cruise-line-you-would-like-to-travel-with" multiple="multiple" className="form-control">&#13;
			<option label="ROYAL CARIBBEAN" value="royal-caribbean">ROYAL CARIBBEAN</option>&#13;
			<option label="CELEBRITY" value="celebrity">CELEBRITY</option>&#13;
			<option label="VIRGIN (ADULT ONLY)" value="virgin-adult-only">VIRGIN (ADULT ONLY)</option>&#13;
			<option label="NORWEGIAN" value="norwegian">NORWEGIAN</option>&#13;
			<option label="DISNEY CRUISE LINE" value="disney-cruise-line">DISNEY CRUISE LINE</option>&#13;
			<option label="HOLLAND AMERICA" value="holland-america">HOLLAND AMERICA</option>&#13;
			<option label="VIKING RIVER" value="viking-river">VIKING RIVER</option>&#13;
			<option label="VIKING OCEAN" value="viking-ocean">VIKING OCEAN</option>&#13;
			<option label="MSC" value="msc">MSC</option>&#13;
			<option label="OTHER" value="other">OTHER</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="OCCUPANCY" name="occupancy" className="form-control">&#13;
			<option label="SINGLE" value="single">SINGLE</option>&#13;
			<option label="DOUBLE" value="double">DOUBLE</option>&#13;
			<option label="TRIPLE" value="triple">TRIPLE</option>&#13;
			<option label="QUAD" value="quad">QUAD</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Type of Cabin" name="type-of-cabin" className="form-control">&#13;
			<option label="INSIDE" value="inside">INSIDE</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="CLUB BALCONY" value="club-balcony">CLUB BALCONY</option>&#13;
			<option label="OTHER - PLEASE INDICATE BELOW UNDER OTHER COMMENTS" value="other-please-indicate-below-under-other-comments">OTHER - PLEASE INDICATE BELOW UNDER OTHER COMMENTS</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Have you sailed with this cruise line&amp;nbsp; before?" name="have-you-sailed-with-viking-before" className="form-control">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Dining&amp;nbsp; (only needed for Holland, Viking Ocean, Celebrity, Disney, RCCL, and MSC." name="dining" className="form-control">&#13;
			<option label="EARLY DINING (USUALLY 5:00 PM)" value="early-dining-usually-500-pm">EARLY DINING (USUALLY 5:00 PM)</option>&#13;
			<option label="LATE DINING (USUALLY 7:30 PM)" value="late-dining-usually-730-pm">LATE DINING (USUALLY 7:30 PM)</option>&#13;
			<option label="OPEN DINING " value="open-dining-">OPEN DINING </option>&#13;
		</field>&#13;
		<field type="select" required="true" label="BILLING / INVOICE" name="billing-invoice" className="form-control">&#13;
			<option label="INVOICE ALL PASSENGERS IN THE ROOM TOGETHER" value="invoice-all-passengers-in-the-room-together">INVOICE ALL PASSENGERS IN THE ROOM TOGETHER</option>&#13;
			<option label="INVOICE ALL PASSENGERS IN THE ROOM INDIVIDUALLY" value="invoice-all-passengers-in-the-room-individually">INVOICE ALL PASSENGERS IN THE ROOM INDIVIDUALLY</option>&#13;
			<option label="I NEED CUSTOM INVOICING - SEE UNDER COMMENTS" value="i-need-custom-invoicing-see-under-comments">I NEED CUSTOM INVOICING - SEE UNDER COMMENTS</option>&#13;
		</field>&#13;
		<field type="textarea" label="Any Dietary or Special Medical Needs we should tell the ship?&amp;nbsp;" description="(ALL GUESTS IN YOUR CABIN  please list name of passenger it applies to)" name="any-dietary-or-special-medical-needs-we-should-tell-the-ship-airline" className="form-control"/>&#13;
		<field type="textarea" label="Any Special Requests?" description="room away from elevator  higher floor  near your friends  not near your friends  etc" name="any-special-requests" className="form-control"/>&#13;
		<field type="textarea" label="Other Comments / Special Needs" name="other-comments-special-needs" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>