<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="TELL ME ABOUT YOUR TRIP"/> <field type="radio-group" label="Which Travel Agent would you like to work with?" inline="true" name="which-travel-agent-would-you-like-to-work-with"> <option label="Jovoanda Reed" value="jovoanda-reed">Jovoanda Reed</option> <option label="Robin Kennedy" value="robin-kennedy">Robin Kennedy</option> <option label="Alia Freeman" value="alia-freeman">Alia Freeman</option> </field> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/> <field type="radio-group" label="Are you celebrating a special occasion?" name="are-you-celebrating-a-special-occasion" other="true"> <option label="Birthday" value="birthday">Birthday</option> <option label="Engagement" value="engagement">Engagement</option> <option label="Honeymoon" value="honeymoon">Honeymoon</option> <option label="Anniversary" value="anniversary">Anniversary</option> <option label="Retirement Celebration" value="retirement-celebration">Retirement Celebration</option> <option label="Summer Break" value="summer-break">Summer Break</option> <option label="Spring Break" value="spring-break">Spring Break</option> <option label="Family Vacation" value="family-vacation">Family Vacation</option> <option label="Family Reunion" value="family-reunion">Family Reunion</option> <option label="Bachelor Party" value="bachelor-party">Bachelor Party</option> <option label="Bachelorette Party" value="bachelorette-party">Bachelorette Party</option> <option label="Graduation" value="graduation">Graduation</option> </field> <field type="header" subtype="h1" label="CRUISE INFORMAITON"/> <field type="select" label="Cruise Line Preference" name="cruise-line-preference" className="form-control"> <option label="" value=""/> <option label="Ama Waterways" value="ama-waterways">Ama Waterways</option> <option label="American Cruise Lines" value="american-cruise-lines">American Cruise Lines</option> <option label="American Queen Voyages" value="american-queen-voyages">American Queen Voyages</option> <option label="Atlas Ocean Voyages" value="atlas-ocean-voyages">Atlas Ocean Voyages</option> <option label="Avalon Waterways" value="avalon-waterways">Avalon Waterways</option> <option label="Azamara Crusies" value="azamara-crusies">Azamara Crusies</option> <option label="Carnival Cruises " value="carnival-cruises-">Carnival Cruises </option> <option label="Celebrity Cruises" value="celebrity-cruises">Celebrity Cruises</option> <option label="Costa Cruises" value="costa-cruises">Costa Cruises</option> <option label="Cunard Line" value="cunard-line">Cunard Line</option> <option label="Disney Cruises" value="disney-cruises">Disney Cruises</option> <option label="Emerald Cruises" value="emerald-cruises">Emerald Cruises</option> <option label="Explora Journeys" value="explora-journeys">Explora Journeys</option> <option label="Holland America" value="holland-america">Holland America</option> <option label="Margaritaville at Sea" value="margaritaville-at-sea">Margaritaville at Sea</option> <option label="MSC Cruises " value="msc-cruises-">MSC Cruises </option> <option label="Norwegian Cruise Line" value="norwegian-cruise-line">Norwegian Cruise Line</option> <option label="Oceania Cruises" value="oceania-cruises">Oceania Cruises</option> <option label="Princess Cruises" value="princess-cruises">Princess Cruises</option> <option label="Viking River Cruises" value="viking-river-cruises">Viking River Cruises</option> <option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option> </field> <field type="select" required="true" label="Departure Port" name="departure-port" className="form-control"> <option label="" value=""/> <option label="Anchorage AK, United States" value="anchorage-ak-united-states">Anchorage AK, United States</option> <option label="Baltimore MD, United States" value="baltimore-md-united-states">Baltimore MD, United States</option> <option label="Bayonne (Cape Liberty) NJ, United States" value="bayonne-cape-liberty-nj-united-states">Bayonne (Cape Liberty) NJ, United States</option> <option label="Boston MA, United States" value="boston-ma-united-states">Boston MA, United States</option> <option label="Brisbane, Australia" value="brisbane-australia">Brisbane, Australia</option> <option label="Brooklyn NY, United States" value="brooklyn-ny-united-states">Brooklyn NY, United States</option> <option label="Calgary AB, Canada" value="calgary-ab-canada">Calgary AB, Canada</option> <option label="Charleston SC, United States" value="charleston-sc-united-states">Charleston SC, United States</option> <option label="Charlotte Amalie (St Thomas), US Virgin Islands" value="charlotte-amalie-st-thomas-us-virgin-islands">Charlotte Amalie (St Thomas), US Virgin Islands</option> <option label="Cozumel, Mexico" value="cozumel-mexico">Cozumel, Mexico</option> <option label="Duluth MN, United States" value="duluth-mn-united-states">Duluth MN, United States</option> <option label="Fort Lauderdale FL, United States" value="fort-lauderdale-fl-united-states">Fort Lauderdale FL, United States</option> <option label="Galveston TX, United States" value="galveston-tx-united-states">Galveston TX, United States</option> <option label="Honolulu HI, United States" value="honolulu-hi-united-states">Honolulu HI, United States</option> <option label="Memphis TN, United States" value="memphis-tn-united-states">Memphis TN, United States</option> <option label="Miami FL, United States" value="miami-fl-united-states">Miami FL, United States</option> <option label="Mobile AL, United States" value="mobile-al-united-states">Mobile AL, United States</option> <option label="New Orleans LA, United States" value="new-orleans-la-united-states">New Orleans LA, United States</option> <option label="New York NY, United States" value="new-york-ny-united-states">New York NY, United States</option> <option label="Norfolk VA, United States" value="norfolk-va-united-states">Norfolk VA, United States</option> <option label="Port Canaveral FL, United States" value="port-canaveral-fl-united-states">Port Canaveral FL, United States</option> <option label="San Diego CA, United States" value="san-diego-ca-united-states">San Diego CA, United States</option> <option label="San Francisco CA, United States" value="san-francisco-ca-united-states">San Francisco CA, United States</option> <option label="San Juan, Puerto Rico" value="san-juan-puerto-rico">San Juan, Puerto Rico</option> <option label="Seattle WA, United States" value="seattle-wa-united-states">Seattle WA, United States</option> <option label="Tampa FL, United States" value="tampa-fl-united-states">Tampa FL, United States</option> <option label="West Palm Beach FL, United States" value="west-palm-beach-fl-united-states">West Palm Beach FL, United States</option> </field> <field type="date" required="true" label="When would you like to depart?" name="when-would-you-like-to-depart" className="form-control"/> <field type="date" required="true" label="When would you like to return?" name="when-would-you-like-to-return" className="form-control"/> <field type="text" required="true" label="How many guests total will be traveling?" name="how-many-guests-total-will-be-traveling" subtype="text" className="form-control"/> <field type="text" required="true" label="How many cabins will you need?" name="how-many-cabins-will-you-need" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="What is your budget per person?" name="what-is-your-budget-per-person"> <option label="up to $500" value="up-to-500">up to $500</option> <option label="$500 - $750" value="500-750">$500 - $750</option> <option label="$750 - 1250" value="750-1250">$750 - 1250</option> <option label="$1250 - $3000" value="1250-3000">$1250 - $3000</option> <option label="$3000+" value="3000">$3000+</option> </field> <field type="radio-group" required="true" label="When are you expecting to book by submitting your deposit?" description="Note the pricing can change without a deposit being paid" name="when-are-you-expecting-to-book-by-submitting-your-deposit"> <option label="ASAP" value="asap">ASAP</option> <option label="Within 3-5 days" value="within-35-days">Within 3-5 days</option> <option label="With 2 weeks" value="with-2-weeks">With 2 weeks</option> <option label="I'm not sure" value="im-not-sure">I'm not sure</option> </field> <field type="radio-group" label="What type of cabin would you like?" name="what-type-of-cabin-would-you-like"> <option label="Interior" value="interior">Interior</option> <option label="Ocean View" value="ocean-view">Ocean View</option> <option label="Balcony" value="balcony">Balcony</option> <option label="Suite" value="suite">Suite</option> </field> <field type="text" label="Are there any medical issues/needs we need to be aware of?" placeholder="i.e. accessible cabin needed autism allergies" name="are-there-any-medical-issuesneeds-we-need-to-be-aware-of" subtype="text" className="form-control"/> <field type="radio-group" label="What time would you like to dine in the Main Dining Room?" name="what-time-would-you-like-to-dine-in-the-main-dining-room"> <option label="Early Dining (5:30pm)" value="early-dining-530pm">Early Dining (5:30pm)</option> <option label="Late Dining (7:45pm)" value="late-dining-745pm">Late Dining (7:45pm)</option> <option label="Anytime Dining (5:30pm to 9:00pm)" value="anytime-dining-530pm-to-900pm">Anytime Dining (5:30pm to 9:00pm)</option> </field> <field type="checkbox-group" label="Would you like to add the following after booking?" toggle="true" name="would-you-like-to-add-the-following-after-booking"> <option label="Specialty Dining" value="specialty-dining">Specialty Dining</option> <option label="Beverage Package" value="beverage-package">Beverage Package</option> <option label="Wi-Fi" value="wifi">Wi-Fi</option> <option label="Shore Excursions" value="shore-excursions">Shore Excursions</option> <option label="Photo Packages" value="photo-packages">Photo Packages</option> <option label="Travel Insurance" value="travel-insurance">Travel Insurance</option> <option label="Pre-paid Gratuities" value="prepaid-gratuities">Pre-paid Gratuities</option> </field> <field type="checkbox-group" label="Will you need pre- or post-cruise travel arrangements?" toggle="true" name="will-you-need-pre-or-postcruise-travel-arrangements"> <option label="Airfare" value="airfare">Airfare</option> <option label="Pre-cruise accommodations" value="precruise-accommodations">Pre-cruise accommodations</option> <option label="Post-cruise accommodations" value="postcruise-accommodations">Post-cruise accommodations</option> <option label="Port Parking Assistance" value="port-parking-assistance">Port Parking Assistance</option> <option label="Shuttle from Airport" value="shuttle-from-airport">Shuttle from Airport</option> <option label="Shuttle from Hotel" value="shuttle-from-hotel">Shuttle from Hotel</option> </field> <field type="header" subtype="h1" label="SPECIAL REQUEST"/> <field type="checkbox-group" label="Medical" toggle="true" name="medical"> <option label="Allergies" value="allergies">Allergies</option> <option label="B-Pap" value="bpap">B-Pap</option> <option label="Blind/Low Vision (kits)" value="blindlow-vision-kits">Blind/Low Vision (kits)</option> <option label="C-Pap" value="cpap">C-Pap</option> <option label="Deaf/Hard of Hearing (kits)" value="deafhard-of-hearing-kits">Deaf/Hard of Hearing (kits)</option> <option label="Diabetic" value="diabetic">Diabetic</option> <option label="Hearing (Interpreter)" value="hearing-interpreter">Hearing (Interpreter)</option> <option label="Motorized Scooter" value="motorized-scooter">Motorized Scooter</option> <option label="Oxygen" value="oxygen">Oxygen</option> <option label="Pregnancy" value="pregnancy">Pregnancy</option> <option label="Service Animal" value="service-animal">Service Animal</option> <option label="Sharps Disposal - In Cabin" value="sharps-disposal-in-cabin">Sharps Disposal - In Cabin</option> <option label="Wheelchair" value="wheelchair">Wheelchair</option> </field> </fields> </form-template> </body> </html>
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