Rachelle Eubanks

The Curious Traveler Co.

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Ireland - Emerald Isle with Globus"/>&#13;
		<field type="paragraph" subtype="p" label="Ireland’s green fields, rich history, and warm welcomes await you. Space is limited — secure your place on this unforgettable journey with The Curious Traveler and Globus."/>&#13;
		<field type="header" subtype="h1" label="Reserve YOUR Spot Today"/>&#13;
		<field type="paragraph" subtype="p" label="Why Book Through The Curious Traveler Co:"/>&#13;
		<field type="paragraph" subtype="p" label="- Exclusive savings not available elsewhere"/>&#13;
		<field type="paragraph" subtype="p" label="- Optional airfare booking and comprehensive travel insurance assistance"/>&#13;
		<field type="paragraph" subtype="p" label="- Personalized service from travel planning through return"/>&#13;
		<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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" 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 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="header" subtype="h1" label="Tour Information"/>&#13;
		<field type="select" label="Number of Travelers" name="number-of-travelers" className="form-control">&#13;
			<option label="1" value="1" selected="selected">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 or more" value="5-or-more">5 or more</option>&#13;
		</field>&#13;
		<field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Would you like assistance with airfare?" name="would-you-like-assistance-with-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="Are you interested in Single or Double Occupancy" name="are-you-interested-in-single-or-double-occupancy">&#13;
			<option label="Single" value="single">Single</option>&#13;
			<option label="Double" value="double">Double</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>