Share your information with Alexandra Jenkins

Alexandra Jenkins

Moms at Sea Travel, a Dream Vacations Franchise

<html>
  <body>
    <form-template>&#13;
	<fields>&#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" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Would you like a phone call to discuss the details of your trip?" name="text-1784502765017" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Would you like a TEXT when I have sent my initial response? My emails can get lost in spam and I find this helps you know when I have responded to your inquiry." name="select-1784504277710" className="form-control">&#13;
			<option label="Yes please" value="yes-please">Yes please</option>&#13;
			<option label="No thank you" value="no-thank-you">No thank you</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many guests total?" name="text-1784502823643" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Any children? If so, what are their ages?" name="text-1784503073761" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Have you been on a cruise before?" name="select-1784503987840" className="form-control">&#13;
			<option label="Yes!" value="yes">Yes!</option>&#13;
			<option label="This will be my first one!" value="this-will-be-my-first-one">This will be my first one!</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="When would you like to sail? Can be exact dates or a general timeframe/season." name="text-1784503932108" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="I don&#39;t know all the details, but I would like these features..." name="select-1785509562835" multiple="multiple" className="form-control">&#13;
			<option label="Perfect Day at Coco Cay" value="perfect-day-at-coco-cay" selected="selected">Perfect Day at Coco Cay</option>&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="European" value="european">European</option>&#13;
			<option label="Alaskan" value="alaskan">Alaskan</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="Waterslides" value="waterslides">Waterslides</option>&#13;
			<option label="Diapered Splash Paf" value="diapered-splash-paf">Diapered Splash Paf</option>&#13;
			<option label="Nursery for 6-36 months" value="nursery-for-636-months">Nursery for 6-36 months</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Cabin Type Preference" inline="true" name="radio-group-1784503529138">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Ocean View" value="ocean-view">Ocean View</option>&#13;
			<option label="Balcony" value="balcony">Balcony</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="Connecting Cabins" value="connecting-cabins">Connecting Cabins</option>&#13;
			<option label="Accessible Cabin" value="accessible-cabin">Accessible Cabin</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="State of Residency and any appropriate cruise loyalty numbers" name="text-1784503725326" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Eligible Discounts" name="radio-group-1784503784075">&#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 (55+)" value="senior-55">Senior (55+)</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Anything else you&#39;d like me to know about this cruise? Any wish list items?" name="textarea-1784503196151" className="form-control"/>&#13;
		<field type="textarea" label="How did you hear about me?" name="textarea-1784502950354" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>