Tracy Stotts Weed, VTA

Tracy Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Pickleballers Registration Form"/>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="paragraph" subtype="p" label="Please input name as it appears on your Drivers License or official form of ID for airline booking"/>&#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" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
		</field>&#13;
		<field type="text" label="Name of Your Roommate" name="name-of-your-roommate" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Room Category" name="room-category">&#13;
			<option label="1 King Bed" value="1-king-bed">1 King Bed</option>&#13;
			<option label="2 Queen Beds" value="2-queen-beds">2 Queen Beds</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Travel Insurance"/>&#13;
		<field type="radio-group" required="true" label="By making an insurance selection below, I understand that declining insurance could result in the loss of my travel cost and/or require more money to correct the situation. I also acknowledge that without insurance, there may be no way to recoup any losses, costs or expenses incurred.*" name="by-making-an-insurance-selection-below-i-understand-that-declining-insurance-could-result-in-the-loss-of-my-travel-cost-andor-require-more-money-to-correct-the-situation-i-also-acknowledge-that-without-insurance-there-may-be-no-way-to-recoup-any-losses-costs-or-expenses-incurred">&#13;
			<option label="I would like to receive a quote for travel insurance" value="i-would-like-to-receive-a-quote-for-travel-insurance">I would like to receive a quote for travel insurance</option>&#13;
			<option label="I decline insurance and understand that this could result in the loss of all travel costs associated with this booking" value="i-decline-insurance-and-understand-that-this-could-result-in-the-loss-of-all-travel-costs-associated-with-this-booking">I decline insurance and understand that this could result in the loss of all travel costs associated with this booking</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Emergency Contact Information"/>&#13;
		<field type="text" label="Full name" name="emergency-contact-full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="emergency-contact-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Relationship to you" name="emergency-contact-relationship" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>