Share your information with Shayla Northcutt

Shayla Northcutt

Northcutt Travel Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Lansangan Wedding Request Form"/>&#13;
		<field type="text" required="true" label="First name" description="Make sure the name you are using is the one on govt ID or passport" 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" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Please provide you partner&#39;s first name, last name, email and phone number" description="Make sure the name you are using is the one on govt ID or passport" name="please-provide-you-partners-first-name-last-name-email-and-phone-number" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to arrive at Secrets Playa Blanca?" name="date-1730387675551" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return home?&amp;nbsp;" name="date-1730387676653" className="form-control"/>&#13;
		<field type="radio-group" label="Will you need airfare?" name="will-you-need-airfare">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What is your Airline Preference?" name="what-is-your-airline-preference">&#13;
			<option label="Southwest" value="southwest">Southwest</option>&#13;
			<option label="United " value="united-">United </option>&#13;
			<option label="American Airlines" value="american-airlines">American Airlines</option>&#13;
			<option label="No preference!" value="no-preference">No preference!</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What are your seating preferences when flying?" description="check all that apply" name="what-are-your-seating-preferences-when-flying">&#13;
			<option label="Economy" value="economy">Economy</option>&#13;
			<option label="Business/ First" value="business-first">Business/ First</option>&#13;
			<option label="Window Seat" value="window-seat">Window Seat</option>&#13;
			<option label="Aisle Seat" value="aisle-seat">Aisle Seat</option>&#13;
			<option label="Opposite Aisle Seat" value="opposite-aisle-seat">Opposite Aisle Seat</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What room category would you like?" name="what-is-your-all-in-budget-per-traveler" other="true">&#13;
			<option label="Junior Suite Ocean View King" value="junior-suite-ocean-view-king">Junior Suite Ocean View King</option>&#13;
			<option label="Junior Suite Ocean View Double" value="junior-suite-ocean-view-double">Junior Suite Ocean View Double</option>&#13;
			<option label="Preferred Club Junior Swim Out King" value="preferred-club-junior-swim-out-king">Preferred Club Junior Swim Out King</option>&#13;
			<option label="Preferred Club Master Suite Ocean Front King" value="preferred-club-master-suite-ocean-front-king">Preferred Club Master Suite Ocean Front King</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Is there anything else you want to share with us regarding your travels?&amp;nbsp;" description="Special Accommodations  Diets  Must Dos or Must Sees, etc" name="is-there-anything-else-you-want-to-share-with-us-regarding-your-travels-" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>