Share your information with Hannah Barbeau

Hannah Barbeau

Travel by Bella

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Disney Cruise Interest Form"/>&#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" subtype="email" required="true" label="E-Mail" name="email" className="form-control"/>&#13;
		<field type="text" subtype="tel" required="true" label="Phone Number" name="phone-number" className="form-control"/>&#13;
		<field type="date" required="true" label="Departure Date" name="departure-date" className="form-control"/>&#13;
		<field type="date" required="true" label="Return Date" name="return-date" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are these dates flexible?" inline="true" name="are-these-dates-flexible">&#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="Number of Travelers" placeholder="All Travelers" name="number-of-travelers" className="form-control">&#13;
			<option label="Solo Traveler" value="solo-traveler">Solo Traveler</option>&#13;
			<option label="Two" value="two">Two</option>&#13;
			<option label="Three" value="three">Three</option>&#13;
			<option label="Four" value="four">Four</option>&#13;
			<option label="Five" value="five">Five</option>&#13;
			<option label="More than 5" value="more-than-5">More than 5</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Age of each Traveler at time of Departure" name="age-of-each-traveler-at-time-of-departure" className="form-control"/>&#13;
		<field type="text" required="true" label="Budget for this Trip" name="budget-for-this-trip" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Is this budget flexible?" inline="true" name="is-this-budge-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Show Me Options" value="show-me-options">Show Me Options</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="All this Ship!"/>&#13;
		<field type="checkbox-group" required="true" label="Disney Ships" inline="true" name="disney-ships">&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
			<option label="Destiny" value="destiny">Destiny</option>&#13;
			<option label="Dream" value="dream">Dream</option>&#13;
			<option label="Fantasy" value="fantasy">Fantasy</option>&#13;
			<option label="Magic" value="magic">Magic</option>&#13;
			<option label="Treasure" value="treasure">Treasure</option>&#13;
			<option label="Wish" value="wish">Wish</option>&#13;
			<option label="Wonder" value="wonder">Wonder</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Staterooms" inline="true" name="staterooms">&#13;
			<option label="Inside" value="inside">Inside</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Verandah" value="verandah">Verandah</option>&#13;
			<option label="Concierge" value="concierge">Concierge</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Deck Preference" inline="true" name="deck-preference">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
			<option label="8" value="8">8</option>&#13;
			<option label="9" value="9">9</option>&#13;
			<option label="10" value="10">10</option>&#13;
			<option label="11" value="11">11</option>&#13;
			<option label="12" value="12">12</option>&#13;
			<option label="13" value="13">13</option>&#13;
			<option label="14" value="14">14</option>&#13;
			<option label="15" value="15">15</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Deck Location" inline="true" name="deck-location">&#13;
			<option label="Forward (Front)" value="forward-front">Forward (Front)</option>&#13;
			<option label="Mid Ship" value="mid-ship">Mid Ship</option>&#13;
			<option label="Aft (Back)" value="aft-back">Aft (Back)</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Port of Departure" inline="true" name="port-of-departure" other="true">&#13;
			<option label="Fort Lauderdale, Florida" value="fort-lauderdale-florida">Fort Lauderdale, Florida</option>&#13;
			<option label="Galveston, Texas" value="galveston-texas">Galveston, Texas</option>&#13;
			<option label="Honolulu, Hawaii" value="honolulu-hawaii">Honolulu, Hawaii</option>&#13;
			<option label="New Orleans, Louisiana" value="new-orleans-louisiana">New Orleans, Louisiana</option>&#13;
			<option label="New York, New York" value="new-york-new-york">New York, New York</option>&#13;
			<option label="Port Canaveral, Florida" value="port-canaveral-florida">Port Canaveral, Florida</option>&#13;
			<option label="San Diego, California" value="san-diego-california">San Diego, California</option>&#13;
			<option label="Vancouver, Canada" value="vancouver-canada">Vancouver, Canada</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Destination Interests" inline="true" name="destination-interests">&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Bahamas" value="bahamas">Bahamas</option>&#13;
			<option label="Bermuda" value="bermuda">Bermuda</option>&#13;
			<option label="Canada" value="canada">Canada</option>&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="Hawaii" value="hawaii">Hawaii</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="New Zealand and Australia" value="new-zealand-and-australia">New Zealand and Australia</option>&#13;
			<option label="Pacific" value="pacific">Pacific</option>&#13;
			<option label="Panama Canal" value="panama-canal">Panama Canal</option>&#13;
			<option label="Singapore" value="singapore">Singapore</option>&#13;
			<option label="South Pacific" value="south-pacific">South Pacific</option>&#13;
			<option label="Translantic" value="translantic">Translantic</option>&#13;
			<option label="Disney Destinations" value="disney-destinations">Disney Destinations</option>&#13;
		</field>&#13;
		<field type="textarea" label="Must Haves:" name="must-haves" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Additional Information"/>&#13;
		<field type="checkbox-group" required="true" label="Do you need planning for any of the following:" name="do-you-need-planning-for-any-of-the-following">&#13;
			<option label="Airfare (Round Trip)" value="airfare-round-trip">Airfare (Round Trip)</option>&#13;
			<option label="Airfare (One Way)" value="airfare-one-way">Airfare (One Way)</option>&#13;
			<option label="Pre-Cruise Lodging" value="precruise-lodging">Pre-Cruise Lodging</option>&#13;
			<option label="Post-Cruise Lodging" value="postcruise-lodging">Post-Cruise Lodging</option>&#13;
			<option label="Rental Car" value="rental-car">Rental Car</option>&#13;
			<option label="Transportation" value="transportation">Transportation</option>&#13;
		</field>&#13;
		<field type="textarea" label="Anything else I should know?" name="anything-else-i-should-know" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>