Share your information with Rachel Zimmerman

Rachel Zimmerman

Moms at Sea, A Dream Vacations Franchise

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		<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="text" required="true" 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="radio-group" label="Would you like a phone call?&amp;nbsp;" name="would-you-like-a-phone-call-">&#13;
			<option label="Yes! As soon as possible!! I'm ready to cruise!" value="yes-as-soon-as-possible-im-ready-to-cruise">Yes! As soon as possible!! I'm ready to cruise!</option>&#13;
			<option label="Yes, but I would like to schedule it." value="yes-but-i-would-like-to-schedule-it">Yes, but I would like to schedule it.</option>&#13;
			<option label="Not at this time." value="not-at-this-time">Not at this time.</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Would you like a TEXT when I have sent my initial response? My emails often get lost in spam and I find this helps you when I have responded to your inquiry.&amp;nbsp;" name="would-you-like-a-text-when-i-have-sent-my-initial-response-my-emails-often-get-lost-in-spam-and-i-find-this-helps-you-when-i-have-responded-to-your-inquiry-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="I don&#39;t know what ship we want, but we want these features:&amp;nbsp;" name="i-dont-know-what-ship-we-want-but-we-want-these-features-e-want-these-features-">&#13;
			<option label="New Jersey Port" value="new-jersey-port">New Jersey Port</option>&#13;
			<option label="Florida Port" value="florida-port">Florida Port</option>&#13;
			<option label="Galveston Port" value="galveston-port">Galveston Port</option>&#13;
			<option label="Alaska Port" value="alaska-port">Alaska Port</option>&#13;
			<option label="European Port" value="european-port">European Port</option>&#13;
			<option label="Waterslides" value="waterslides">Waterslides</option>&#13;
			<option label="Nursery for children 6-36 months" value="nursery-for-children-636-months">Nursery for children 6-36 months</option>&#13;
			<option label="Diapered Splash Pad" value="diapered-splash-pad">Diapered Splash Pad</option>&#13;
			<option label="Splash Pad for Potty Trained Kids" value="splash-pad-for-potty-trained-kids">Splash Pad for Potty Trained Kids</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="How many guests?" name="how-many-guests">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6+" value="6">6+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="How many guests age 12 and under?&amp;nbsp;" name="how-many-guests-age-12-and-under-">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5+" value="5">5+</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Cabin type preference:&amp;nbsp;" name="cabin-type-preference-">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Cabins that accommodate 5+" value="cabins-that-accommodate-5">Cabins that accommodate 5+</option>&#13;
			<option label="Accessible Cabin" value="accessible-cabin">Accessible Cabin</option>&#13;
			<option label="Connecting Cabins" value="connecting-cabins">Connecting Cabins</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Which cruise line are you interested in?&amp;nbsp;" name="which-cruise-line-are-you-interested-in-">&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Celebrity" value="celebrity">Celebrity</option>&#13;
			<option label="Disney" value="disney">Disney</option>&#13;
			<option label="Carnival" value="carnival">Carnival</option>&#13;
			<option label="NCL" value="ncl">NCL</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have any thoughts on your experience you&#39;d like to share? Anything on your wish list?&amp;nbsp;" name="do-you-have-any-thoughts-on-your-experience-youd-like-to-share-anything-on-your-wish-list-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Have you cruised before? If so, please share your experience!" name="have-you-cruised-before-if-so-please-share-your-experience" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How did you hear about me?" name="how-did-you-hear-about-me" subtype="text" className="form-control"/>&#13;
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