Share your information with Shannon Miller

Shannon Miller

Serene Sage Escapes

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#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="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="text" required="true" label="Are these dates flexible?" name="are-these-dates-flexible" value="please specify " subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Departure port preference" name="departure-port-preference" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Cabin type preference" name="cabin-type-preference" value="inside, ocean view, balcony, suite" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Preferred cruise line(s), if any." name="preferred-cruise-lines-if-any" value="Virgin Voyages, Carnival, etc.." subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Cruise length&amp;nbsp;" name="cruise-length-" other="true">&#13;
			<option label="3-5 Nights" value="35-nights">3-5 Nights</option>&#13;
			<option label="6-8 Nights " value="68-nights-">6-8 Nights </option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Destination preferences" name="destination-preferences" other="true">&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Mediterranean" value="mediterranean">Mediterranean</option>&#13;
			<option label="Alaskan" value="alaskan">Alaskan</option>&#13;
			<option label="Europen" value="europen">Europen</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Budget range per person" name="budget-range-per-person" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Any must-have amenities?" name="any-musthave-amenities" other="true">&#13;
			<option label="Drinking Package" value="drinking-package">Drinking Package</option>&#13;
			<option label="Excursions" value="excursions">Excursions</option>&#13;
			<option label="Specialty Dining" value="specialty-dining">Specialty Dining</option>&#13;
			<option label="Spa" value="spa">Spa</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Is this for a special occasion?" name="is-this-for-a-special-occasion" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Would you like airfare and pre/post-cruise hotel arranged as well?" name="would-you-like-airfare-and-prepostcruise-hotel-arranged-as-well" other="true">&#13;
			<option label="Airfare and Pre/Post Hotels" value="airfare-and-prepost-hotels">Airfare and Pre/Post Hotels</option>&#13;
			<option label="Airfare" value="airfare">Airfare</option>&#13;
			<option label="Pre-Hotel" value="prehotel">Pre-Hotel</option>&#13;
			<option label="Post-Hotel" value="posthotel">Post-Hotel</option>&#13;
		</field>&#13;
		<field type="textarea" label="Is there anything else you want me to know?" name="is-there-anything-else-you-want-me-to-know" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>