Share your information with Lindsay Gilliam

Lindsay Gilliam

Travelmation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="paragraph" subtype="p" label="Please fill out this form so we can stay connected!"/>&#13;
		<field type="header" subtype="h2" label="Let&#39;s Get Connected!"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#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" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="date" required="true" label="Wedding Date" name="wedding-anniversary" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Travel Interests"/>&#13;
		<field type="radio-group" required="true" label="Hotel preference" name="hotel-preference">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Activity Preferences" name="activity-preferences">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Family Fun" value="family-fun">Family Fun</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theatre" value="art-theatre">Arts and theatre</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Destination Types" name="destination-types">&#13;
			<option label="Disney Destinations" value="disney-destinations">Disney Destinations</option>&#13;
			<option label="Cruising" value="cruising">Cruising</option>&#13;
			<option label="Theme Parks" value="theme-parks">Theme Parks</option>&#13;
			<option label="All-Inclusive" value="allinclusive">All-Inclusive</option>&#13;
			<option label="National Parks" value="national-parks">National Parks</option>&#13;
			<option label="International" value="international">International</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>