Jen Mitchell

Jen Mitchell Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Lead Guest | Full name (as it appears on your passport)"/>&#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 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="date" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="text" label="Which Camp Do You Attend?" name="which-camp-do-you-attend" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Would you be interested in paying additional for motorcoach?" name="would-you-be-interested-in-paying-additional-for-motorcoach" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Would you attend a group workout on embarkation day @ 3pm? If so, how many in your party would attend? (Adults only)" name="would-you-want-a-group-workout-on-embarkation-day-or-6am-or-neither" 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="Line 2" name="address-line-2" 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 type="file" label="Photo of passport ID page" name="passport_photo" subtype="file" className="form-control"/>&#13;
		<field type="checkbox-group" label="What Room Category are you interested in ?" name="what-room-category-are-you-interested-in-" other="true">&#13;
			<option label="Suite" value="Suite">Suite</option>&#13;
			<option label="2D Oceanview Balcony" value="2d-oceanview-balcony">2D Oceanview Balcony</option>&#13;
			<option label="4D Oceanview Balcony" value="4d-oceanview-balcony">4D Oceanview Balcony</option>&#13;
			<option label="2I Boardwalk Balcony" value="2i-boardwalk-balcony">2I Boardwalk Balcony</option>&#13;
			<option label="2J Central Park Balcony" value="2j-central-park-balcony">2J Central Park Balcony</option>&#13;
			<option label="2N Ocean View" value="2n-ocean-view">2N Ocean View</option>&#13;
			<option label="Inside Cabin" value="inside-cabin">Inside Cabin</option>&#13;
		</field>&#13;
		<field type="textarea" label="Additional Requests:&amp;nbsp;" name="additional-requests-" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Guest 2 (name as it appears on passport):&amp;nbsp;"/>&#13;
		<field type="text" label="Guest 2 Name:" name="guest-2-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Guest 2 DOB:" name="guest-2-dob" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Guest 3 (name as it appears on passport):&amp;nbsp;"/>&#13;
		<field type="text" label="Guest 3 Name:" name="guest-3-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Guest 3 DOB:" name="guest-3-dob" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Guest 4 (name as it appears on passport):&amp;nbsp;"/>&#13;
		<field type="text" label="Guest 4 Name:" name="guest-4-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Guest 4 DOB:" name="guest-4-dob" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Guest 5 (name as it appears on passport):&amp;nbsp;"/>&#13;
		<field type="text" label="Guest 5 Name:" name="guest-5-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Guest 5 DOB:" name="guest-5-dob" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Guest 6 (name as it appears on passport):&amp;nbsp;"/>&#13;
		<field type="text" label="Guest 6 Name:" name="guest-6-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Guest 6 DOB:" name="guest-6-dob" className="form-control"/>&#13;
		<field type="text" label="Text Field" name="text-1737405822579" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Text Field" name="text-1738005779547" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>