Megan Farwell

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-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="radio-group" required="true" label="Preferred Method of Contact" name="preferred-method-of-contact">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
		</field>&#13;
		<field type="textarea" label="Additional Travelers?&amp;nbsp; List Name and Age for Each Person" placeholder="Ex. 2 adults, 2 kids:  Megan - 38, Steve - 39, Ally - 12, Bennett - 10" name="additional-travelers-list-name-and-age-for-each-person" className="form-control"/>&#13;
		<field type="textarea" label="Dates of Travel" description="This can be a general idea and can be changed later" placeholder="Ex. Specific cruise dates or month/year" name="dates-of-travel" className="form-control"/>&#13;
		<field type="radio-group" label="Budget for All Travelers?" description="This just gives me a general starting point and can always be changed later." name="budget-for-all-travelers">&#13;
			<option label="$1500-$2500" value="15002500" selected="selected">$1500-$2500</option>&#13;
			<option label="$2500-$4500" value="25004500">$2500-$4500</option>&#13;
			<option label="$4500-$6500" value="45006500">$4500-$6500</option>&#13;
			<option label="$6500-$8500" value="65008500">$6500-$8500</option>&#13;
			<option label="$8500-$10,000" value="850010000">$8500-$10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="select" label="Stateroom Preference?" name="stateroom-preference" multiple="multiple" className="form-control">&#13;
			<option label="Inside" value="inside" selected="selected">Inside</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Verandah" value="verandah">Verandah</option>&#13;
			<option label="Concierge (suites)" value="concierge-suites">Concierge (suites)</option>&#13;
			<option label="Help Me Decide" value="help-me-decide">Help Me Decide</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Have you cruised with Disney before?" name="have-you-cruised-with-disney-before">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Have cruised but different cruise line" value="have-cruised-but-different-cruise-line">Have cruised but different cruise line</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know?" placeholder="Ex. bduget, preferences, your ideal cruise, etc!" name="what-else-would-you-like-me-to-know" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>