Share your information with Elora Duda

Elora Duda

Moms at Sea Travel, a Dream Vacations Franchise

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    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>&#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="radio-group" required="true" label="Would you like a phone call?" name="would-you-like-a-phone-call">&#13;
			<option label="Yes, ASAP - I'm ready to cruise!" value="yes-asap-im-ready-to-cruise">Yes, ASAP - I'm ready to cruise!</option>&#13;
			<option label="Yes, but I'd like to schedule it." value="yes-but-id-like-to-schedule-it">Yes, but I'd like to schedule it.</option>&#13;
			<option label="Not at this time, thanks." value="not-at-this-time-thanks">Not at this time, thanks.</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Would you like me to TEXT you when I have sent my initial response? My emails often get lost in spam and I find this helps you know I have responded to your inquiry." name="would-you-like-me-to-text-you-when-i-have-sent-my-initial-response-my-emails-often-get-lost-in-spam-and-i-find-this-helps-you-know-i-have-responded-to-your-inquiry">&#13;
			<option label="Yes please!" value="yes-please">Yes please!</option>&#13;
			<option label="No thanks!" value="no-thanks">No thanks!</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How did you hear about me?" name="text-1769694782165" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Which cruise line are you interested in?" name="which-cruise-line-are-you-interested-in">&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Other - Please list in comments below" value="other-please-list-in-comments-below">Other - Please list in comments below</option>&#13;
		</field>&#13;
		<field type="text" label="What is your preferred departure port?" name="text-1769694800018" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many guests total?" name="text-1769694798370" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Please list the ages of any children traveling:" name="text-1769694794602" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What dates (or date range) are you looking to sail?" name="what-dates-or-date-range-are-you-looking-to-sail" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="I&#39;m definitely looking for these features:" name="checkbox-group-1769695512498">&#13;
			<option label="Perfect Day at CocoCay" value="perfect-day-at-cococay">Perfect Day at CocoCay</option>&#13;
			<option label="Waterslides" value="waterslides">Waterslides</option>&#13;
			<option label="Diapered baby splash pad" value="diapered-baby-splash-pad">Diapered baby splash pad</option>&#13;
			<option label="Splash pad for potty trained kids" value="splash-pad-for-potty-trained-kids">Splash pad for potty trained kids</option>&#13;
			<option label="Nursery 6M-36M" value="nursery-6m36m">Nursery 6M-36M</option>&#13;
			<option label="Other - Please list in comments below" value="other-please-list-in-comments-below">Other - Please list in comments below</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What type of cabin are you most interested in?" name="checkbox-group-1769695507715">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Cabin that can accomodate 5+" value="cabin-that-can-accomodate-5">Cabin that can accomodate 5+</option>&#13;
			<option label="Accessible Cabin" value="accessible-cabin">Accessible Cabin</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Eligible Discounts" name="checkbox-group-1769695502737">&#13;
			<option label="Military" value="military">Military</option>&#13;
			<option label="Law Enforcement" value="law-enforcement">Law Enforcement</option>&#13;
			<option label="EMT/First Responder" value="emtfirst-responder">EMT/First Responder</option>&#13;
			<option label="Senior" value="senior">Senior</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="State of Residency?" name="text-1769694796154" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Any applicable cruise loyalty number?" placeholder="ex: Crown and Anchor Society" name="any-applicable-cruise-loyalty-number" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Anything else you would like me to know about this cruise?" placeholder="ex: previous cruise history  ship or class you&#39;re interested in  specific port or feature you&#39;re looking for, something you&#39;re celebrating, etc." name="textarea-1769694783792" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
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