Share your information with Codi Warfield

Codi Warfield

Breakthrough Travel Co

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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" label="Phone number" name="phone-number" 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="How many people would be traveling with you?&amp;nbsp;" name="text-1789677919155" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="What type of stateroom are you interested in?&amp;nbsp;" name="checkbox-group-1789677990844">&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Inside" value="inside">Inside</option>&#13;
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		<field type="checkbox-group" label="Have you cruised with Norwegian Cruise Line before?" name="checkbox-group-1789678029628">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No " value="no-">No </option>&#13;
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		<field type="checkbox-group" label="Preferred method of contact" name="checkbox-group-1789678077482">&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Email " value="email-">Email </option>&#13;
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		<field type="text" label="Anything else you would like me to know?&amp;nbsp;" name="text-1789678130375" subtype="text" className="form-control"/>&#13;
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