<form-template>
	<fields>
		<field type="header" subtype="h1" label="DEPOSIT INFORMATION FOR ITALY"/>
		<field type="paragraph" subtype="p" label="So excited that you want to join us for Italy 2022! I would like to make your vacation hassle free and finalizing accurate paperwork is an essential step. In an effort to ensure proper travel documentation requirements are met and security issues are avoided; please complete the following form fully and accurately. All submitted information is secure, properly protected, and used exclusively for your upcoming reservation. It comes only to me, Jana Huse, via email and then I will input to confirm the reservation."/>
		<field type="header" subtype="h2" label="PERSON MAKING THE RESERVATION:"/>
		<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" label="Preferred name" name="preferred-name" 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="text" label="Any comments, additional changes or deletions we have discussed? Special food diet needed?" name="any-comments-additional-changes-or-deletions-we-have-discussed-special-food-diet-needed" subtype="text" className="form-control"/>
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>
		<field type="header" subtype="h2" label="Passport Info"/>
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>
		<field type="radio-group" label="Gender" name="gender">
			<option label="F" value="female">F</option>
			<option label="M" value="male">M</option>
		</field>
		<field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>
		<field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/>
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Please tell me your plans for air... Would you like us to book it? Flying from? Airline preferred? Upgraded seats? Pre/Post stay?" name="please-tell-me-your-plans-for-air-would-you-like-us-to-book-it-airline-preferred-upgraded-seats-prepost-stay" subtype="text" className="form-control"/>
		<field type="text" label="KNOWN TRAVELER IDS/TSA PRE CHECK&amp;nbsp;" name="known-traveler-idstsa-pre-check-enter-for-both" subtype="text" className="form-control"/>
		<field type="header" subtype="h2" label="ENTER DETAILS FOR SECOND TRAVELER IN YOUR ROOM HERE"/>
		<field type="textarea" label="Additional travelers full legal name and birthdays" name="additional-travelers-full-legal-name-and-birthdays" className="form-control"/>
		<field type="header" subtype="h1" label="TRAVEL INSURANCE"/>
		<field type="paragraph" subtype="p" label="I believe that your upcoming trip is a significant investment which you should protect. For this reason I strongly recommend you purchase Travel Insurance. If you choose to decline this valuable protection you are assuming any financial loss associated with your travel arrangements. Travel insurance purchases must be done at time of deposit. All deposits and payments are non-refundable unless entire trip is canceled. Final Pricing is based on age and amount of coverage.&amp;nbsp; CANCEL ANYTIME COVERAGE MUST BE PURCHASED AT THE TIME OF DEPOSIT.&amp;nbsp; More details at https://www.travelooza.com/travelinsurance.html"/>
		<field type="select" required="true" label="Our choice for travel insurance" description="NOTE: Price is based on age and amount of coverage. If you are interested in some other options  call Jana to discuss!" name="our-choice-for-travel-insurance" className="form-control">
			<option label="I would like a quote for the Cancel For Any Reason policy" value="i-would-like-a-quote-for-the-cancel-for-any-reason-policy" selected="true">I would like a quote for the Cancel For Any Reason policy</option>
			<option label="I would like a quote for the Classic Policy" value="i-would-like-a-quote-for-the-classic-policy">I would like a quote for the Classic Policy</option>
			<option label="I do not wish to purchase travel insurance." value="i-do-not-wish-to-purchase-travel-insurance">I do not wish to purchase travel insurance.</option>
		</field>
		<field type="header" subtype="h2" label="Address"/>
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>
		<field type="text" label="Emergency Contact Name" name="emergency-contact-name" subtype="text" className="form-control"/>
		<field type="text" label="Emergency Contact Phone" name="emergency-contact-phone" subtype="text" className="form-control"/>
		<field type="text" label="Emergency Contact Email Address" name="emergency-contact-email-address" subtype="text" className="form-control"/>
		<field type="radio-group" required="true" label="Payment Method Choice -- (if bank card I will send another link to submit that securely)" name="payment-method-choice-if-bank-card-i-will-send-another-link-to-submit-that-securely">
			<option label="Bank Draft" value="bank-draft">Bank Draft</option>
			<option label="Bank Card.. will add 3.5% fee" value="bank-card-will-add-35-fee">Bank Card.. will add 3.5% fee</option>
		</field>
		<field type="textarea" label="If bank draft, please enter your routing number and account number here.&amp;nbsp; &amp;nbsp;" name="if-bank-draft-please-enter-your-routing-number-and-account-number-here-" className="form-control"/>
	</fields>
</form-template>