Share your information with Jordan Dorman

Jordan Dorman

Moms at Sea Travel, a Dream Vacation Franchise

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#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="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone Number" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Do you know what sail date you&#39;d like?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/>&#13;
		<field type="text" label="How many total guests?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Any children? If so, what are their ages?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="I would like these features:" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Perfect Day at CocoCay or other private island" value="perfect-day-at-cococay-or-other-private-island">Perfect Day at CocoCay or other private island</option>&#13;
			<option label="Water Slides on Ship" value="water-slides-on-ship">Water Slides on Ship</option>&#13;
			<option label="Diapered Splash Pad" value="diapered-splash-pad">Diapered Splash Pad</option>&#13;
			<option label="Nursery for 6-36 month old" value="nursery-for-636-month-old">Nursery for 6-36 month old</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;
		</field>&#13;
		<field type="checkbox-group" label="What kind of cabin/suite are you interested in?" description="Check all that apply" name="activity-preferences">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Ocean view window" value="ocean-view-window">Ocean view window</option>&#13;
			<option label="Ocean view balcony" value="ocean-view-balcony">Ocean view balcony</option>&#13;
			<option label="Boardwalk or Central Park (Royal Oasis and Icon Class only)" value="boardwalk-or-central-park-royal-oasis-and-icon-class-only">Boardwalk or Central Park (Royal Oasis and Icon Class only)</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Cabins that accommodate 5+" value="cabins-that-accommodate-5">Cabins that accommodate 5+</option>&#13;
			<option label="Accessible cabin" value="accessible-cabin">Accessible cabin</option>&#13;
			<option label="Connecting cabins" value="connecting-cabins">Connecting cabins</option>&#13;
		</field>&#13;
		<field type="text" label="State of residency and any cruise loyalty numbers?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What can you tell me about the cruise you are looking for? Anything on your wish list? Preferred cruise line?&amp;nbsp;" description="Looking forward to helping plan the perfect vacation for you!!" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>