Share your information with Brenda Otto

Brenda Otto

SunRay Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h3" label="Client Information"/>&#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="date" required="true" label="Date of Birth" name="date-1766287136358" 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="header" subtype="h3" label="Address"/>&#13;
		<field type="text" required="true" label="Street" name="address-line-1" 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" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Dates of Travel" name="checkbox-group-1776047648938">&#13;
			<option label="September 21 - 25, 2027" value="september-21-25-2027">September 21 - 25, 2027</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Select Room Category Option" description="Please select ONLY ONE " inline="true" name="checkbox-group-1776047498176">&#13;
			<option label="Premium Room - DOUBLE OCCUPANCY" value="premium-room-double-occupancy">Premium Room - DOUBLE OCCUPANCY</option>&#13;
			<option label="Premium Room - SINGLE OCCUPANCY" value="premium-room-single-occupancy">Premium Room - SINGLE OCCUPANCY</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Companion Full Name / Person Sharing the Room" description="If single occupancy type in NONE" placeholder="Please provide First and Last Name" name="text-1766287304161" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Please provide Date of Birth of Person Sharing the Room" description="If single occupancy type in NONE" name="text-1774967748970" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Travel Insurance Quote" description="Are you interested in receiving a Travel Insurance Quote" inline="true" name="checkbox-group-1786647493566">&#13;
			<option label="Yes, please provide a quote" value="yes-please-provide-a-quote">Yes, please provide a quote</option>&#13;
			<option label="No, decline Travel Protection" value="no-decline-travel-protection">No, decline Travel Protection</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Excursion - Only indicate if you are DECLINING these activities" description="If only one interests you ONLY check the excursion you are not interested in" inline="true" name="checkbox-group-1786649178271">&#13;
			<option label="Not interested in Muyil Excursion" value="not-interested-in-muyil-excursion">Not interested in Muyil Excursion</option>&#13;
			<option label="Not interested in Cenote Excursion" value="not-interested-in-cenote-excursion">Not interested in Cenote Excursion</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Let&#39;s Review the Fine Print"/>&#13;
		<field type="checkbox-group" required="true" label="Please understand that while planning your trip, we will primarily be in contact via email or scheduled phone calls. This approach provides you with the best level of service while ensuring that no important information is overlooked. We strongly discourage questions via text message in order to maintain accuracy and clarity while we plan your trip. In advance of your departure date, we will provide you the best local contact information for prompt assistance after business hours. Unscheduled calls and texts are of course available to you for any in-travel emergencies that arise." name="checkbox-group-1766288582788">&#13;
			<option label="Yes, I understand and agree" value="yes-i-understand-and-agree">Yes, I understand and agree</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>