Laura Hilbig & Lisa Balek

L & L Travel Co.

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  <body>
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	<fields>&#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="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" 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" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Are you interested in ..." name="are-you-interested-in-" className="form-control">&#13;
			<option label="Day Trips" value="day-trips" selected="selected">Day Trips</option>&#13;
			<option label="Multi Day Extensions" value="multi-day-extensions">Multi Day Extensions</option>&#13;
		</field>&#13;
		<field type="textarea" label="Let us know how you plan to travel! Will you be joining us with a group, your parish, or going solo?" name="let-us-know-how-you-plan-to-travel-will-you-be-joining-us-with-a-group-your-parish-or-going-solo" className="form-control"/>&#13;
		<field type="textarea" label="Questions for L &amp;amp; L&amp;nbsp;" name="questions-for-l-l-" className="form-control"/>&#13;
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