Share your information with Jenita Lawal

Jenita Lawal

Lawal Travel Services

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  <body>
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	<fields>&#13;
		<field type="header" subtype="h2" label="Registration Form"/>&#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" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Primary phone number" name="phone-number" 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="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
		</field>&#13;
		<field type="file" label="Passport photo" name="passport_photo" subtype="file" className="form-control"/>&#13;
		<field type="text" required="true" label="Spouse/Roommate Name (as it appears on passport)" placeholder="If your Roommate is not your spouse/SO  an individual form is needed for each person" name="spouseroommate-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Spouse/Roommate DOB &amp;amp; Passport Info" placeholder="If your roommate is your spouse/SO  please add their DOB and Passport info" name="spousesignificant-other-info" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="checkbox-group" label="Check all components you need:" inline="true" name="check-all-components-you-need">&#13;
			<option label="Roundtrip Flights" value="roundtrip-flights">Roundtrip Flights</option>&#13;
			<option label="Lodging" value="lodging">Lodging</option>&#13;
			<option label="Ground transportation" value="ground-transportation">Ground transportation</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Other - note in comments" value="other-note-in-comments">Other - note in comments</option>&#13;
		</field>&#13;
		<field type="date" required="true" label="Departure Date" name="departure-date" className="form-control"/>&#13;
		<field type="date" required="true" label="Return Date" name="return-date" className="form-control"/>&#13;
		<field type="radio-group" label="Seat preference" name="seat-preference">&#13;
			<option label="Window" value="window">Window</option>&#13;
			<option label="Aisle" value="aisle">Aisle</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" name="bed-preference">&#13;
			<option label="King/single bed" value="kingsingle-bed">King/single bed</option>&#13;
			<option label="2 beds" value="2-beds" selected="selected">2 beds</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Are you interested in Travel Insurance?" name="are-you-interested-in-travel-insurance">&#13;
			<option label="Yes - send me a quote" value="yes-send-me-a-quote">Yes - send me a quote</option>&#13;
			<option label="No - I understand the risk" value="no-i-understand-the-risk">No - I understand the risk</option>&#13;
			<option label="Maybe - I'll decide later" value="maybe-ill-decide-later">Maybe - I'll decide later</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Acknowledgements"/>&#13;
		<field type="checkbox-group" required="true" label="I understand that Lawal Travel Services charges a 10% cancellation fee, in addition to any vendor/hotel cancelation fees and penalties" inline="true" name="i-understand-that-lawal-travel-services-charges-a-10-cancellation-fee-in-addition-to-any-vendorhotel-cancelation-fees-and-penalties">&#13;
			<option label="Yes, I understand" value="yes-i-understand" selected="selected">Yes, I understand</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="I understand that Lawal Travel Services charges a $75 fee for changes to my booking, this includes changes related to Price Guarantees.&amp;nbsp;" name="i-understand-that-lawal-travel-services-charges-a-50-fee-for-changes-to-my-booking-this-includes-changes-related-to-price-guarantees-">&#13;
			<option label="Yes, I understand" value="yes-i-understand">Yes, I understand</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Emergency Contact"/>&#13;
		<field type="text" required="true" label="Full Name" name="full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" subtype="tel" required="true" label="Contact Number" name="contact-number" className="form-control"/>&#13;
		<field type="text" required="true" label="Relationship to you" name="text-1591484748482" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Additional Information"/>&#13;
		<field type="text" label="Do you have any medical conditions we need to be aware of?" name="do-you-have-any-medical-conditions-we-need-to-be-aware-of" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Anything else you think we should know? Add any special instructions here.&amp;nbsp;" name="anything-else-you-think-we-should-know" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Please list any food allergies." name="text-1792266952300" subtype="text" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Once your form is received, we will create your booking and send you a payment link or invoice (depending on the trip) within 24 hours. Please direct any questions to team@lawaltravel.com or text 629.222.3886. Thank you for choosing Lawal Travel Services.&amp;nbsp;"/>&#13;
		<field type="header" subtype="h1" label="Thank you!"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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