Felicia Evans

Amilly Luxury Travels

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	<fields>&#13;
		<field type="header" subtype="h1" label="Dixon-Dickerson Family Reunion 2025 Registration Form"/>&#13;
		<field type="paragraph" subtype="p" label="Reuniting in the Greater Chicago area, where memories are made and family bonds grow stronger. Here is to laughter, love, and making timeless memories at our 2025 family reunion! We are thrilled to extend a warm invitation to you and your loved ones for our much-anticipated 2025 Family Reunion, taking place in the vibrant city of Chicago! Mark your calendars for July 10, 2025 to July 13, 2025 as we come together to celebrate our cherished family ties and create unforgettable memories."/>&#13;
		<field type="radio-group" required="true" label="Select one option:" description="A family is 2 or more persons including spouse or significant AND child(ren) 18 and under" inline="true" name="family-or-individual-pass-">&#13;
			<option label="Single $75.00" value="single-7500">Single $75.00</option>&#13;
			<option label="Couples $150.00" value="couples-15000">Couples $150.00</option>&#13;
			<option label="Family $200  (2 Adults + Children)" value="family-200-2-adults-children">Family $200  (2 Adults + Children)</option>&#13;
		</field>&#13;
		<field type="text" label="Deposit &amp;amp; Payment Information&amp;nbsp;" name="dates-deposit-information-" value="$50 Deposit Per Family due by February 28, 2025 Final Payment Due: April 1, 2025" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Ways to Pay:&amp;nbsp;"/>&#13;
		<field type="text" label="Option#1: Zelle" name="option1-zelle" value="Zelle Payment to phone number: (847)-508-6743" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Option#2 :&amp;nbsp; Please mail to:&amp;nbsp;" name="option2-money-orders-only" value="Please mail to:   Dixon-Dickerson Family Reunion 2025 at P.O. Box 8375 Waukegan  IL 60079       Payable to:   Memo: Payee Name &amp; # Of People" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Primary Traveler Name"/>&#13;
		<field type="text" label="Prefix" 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="text" label="Age of primary traveler" name="age-of-primary-traveler" 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="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email Address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Confirm Email Address" name="confirm-email-address" 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="header" subtype="h1" label="How are you related to the Dixon-Dickerson family?"/>&#13;
		<field type="text" required="true" label="Text Field" name="text-1728933746298" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Travel Dates"/>&#13;
		<field type="radio-group" required="true" label="What dates will you arrive and depart on?&amp;nbsp;" description="2 days  3 days  4 days" inline="true" name="radio-group-1665436172696" other="true">&#13;
			<option label="July 10, 2025-July 13, 2025" value="july-10-2025july-13-2025">July 10, 2025-July 13, 2025</option>&#13;
			<option label="July 09, 2025-July 13, 2025" value="july-09-2025july-13-2025">July 09, 2025-July 13, 2025</option>&#13;
			<option label="July 10, 2025-July 14, 2025" value="july-10-2025july-14-2025">July 10, 2025-July 14, 2025</option>&#13;
			<option label="" value=""/>&#13;
		</field>&#13;
		<field type="text" required="true" label="Enter Number of People" name="text-1665435683068" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Name and Ages of All OtherTravelers"/>&#13;
		<field type="text" label="Name of 2nd Traveler" description="Name as it appears on your identification" name="name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Age of 2nd Traveler" description="Name as it appears on your identification" name="age" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Name of 3rdTraveler" description="Name as it appears on your identification" name="text-1665436895677" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Age of 3rd Traveler" description="Name as it appears on your identification" name="text-1665436898635" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Name of&amp;nbsp; 4thTraveler" description="Name as it appears on your identification" name="text-1665436907220" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Age of 4th Traveler" name="text-1665436905120" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Name of 5th Traveler" description="Name as it appears on your identification" name="name-of-5th-traveler" className="form-control">&#13;
			<option label="" value=""/>&#13;
			<option label="Option 3" value="option-3">Option 3</option>&#13;
		</field>&#13;
		<field type="text" label="Age of 5th Traveler" name="age-of-5th-traveler" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Name of 6th traveler" description="Name as it appears on your identification" name="text-1679865949353" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Age of 6th Traveler" description="Name as it appears on your identification" name="text-1679866010203" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Dixon-Dickerson Room Reservation Block:"/>&#13;
		<field type="textarea" label="Text Area" name="textarea-1728933555692" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Will you be ordering t-shirts for the reunion?&amp;nbsp;"/>&#13;
		<field type="select" required="true" label="Select" name="select-1" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Quantity&amp;nbsp;" name="quantity-" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
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