Share your information with Tyisha Greenleaf

Tyisha Greenleaf

Greenleaf Voyages

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full Government Name, Date of Birth, &amp;amp; Gender (for each traveler)"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" placeholder="Mr  Ms  Mrs." name="prefix" subtype="text" className="form-control"/>&#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="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" 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" 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="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" 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="radio-group" label="Cruise Line" name="cruise-line">&#13;
			<option label="Carnival" value="Carnival">Carnival</option>&#13;
			<option label="Princess" value="Princess">Princess</option>&#13;
			<option label="Norwegian" value="Norwegian">Norwegian</option>&#13;
			<option label="Royal Caribbean" value="Royal Caribbean">Royal Caribbean</option>&#13;
			<option label="Virgin Voyages" value="Virgin Voyages">Virgin Voyages</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Stateroom&amp;nbsp; preference" description="subject to availability" name="seat-preference" other="true">&#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;
		</field>&#13;
		<field type="radio-group" label="Gratuities be added" name="gratuities-be-added">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Unknown at this time" value="unknown-at-this-time">Unknown at this time</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Travel Insurance&amp;nbsp;" name="will-carnival-vacation-protection-or-allianz-be-added">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Give me a quote" value="give-me-a-quote">Give me a quote</option>&#13;
			<option label="Unknown at this time" value="unknown-at-this-time">Unknown at this time</option>&#13;
		</field>&#13;
		<field type="select" label="Meal Preference Time" placeholder="If not selected  you will be automatically placed in Your Time Dining" name="meal-preference-time" className="form-control">&#13;
			<option label="Early Dining (5:00pm)- Royal Caribbean Cruise" value="early-dining-500pm-royal-caribbean-cruise">Early Dining (5:00pm)- Royal Caribbean Cruise</option>&#13;
			<option label="Early Dining (5:30pm)- Carnival Cruise Line" value="early-dining-530pm-carnival-cruise-line">Early Dining (5:30pm)- Carnival Cruise Line</option>&#13;
			<option label="Late Dining (8:00pm)" value="late-dining-800pm">Late Dining (8:00pm)</option>&#13;
			<option label="Your Time Dining (5:00pm to 9:00pm)" value="your-time-dining-500pm-to-900pm">Your Time Dining (5:00pm to 9:00pm)</option>&#13;
		</field>&#13;
		<field type="textarea" label="Additional Travelers (First and Last Name: Date of Birth: State of Residence: Email Address: Telephone Number: (for each traveler)" name="special-request" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>