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<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="&amp;nbsp;Ocean Allure Costa Mujeres"/>&#13;
		<field type="header" subtype="h1" label="Deposit: $50 p/p | Final Payment: March 13th"/>&#13;
		<field type="header" subtype="h1" label="Single: $1175 | Double: $900 p/p"/>&#13;
		<field type="radio-group" required="true" label="Occupancy&amp;nbsp;" name="occupancy-">&#13;
			<option label="Single" value="single">Single</option>&#13;
			<option label="Double" value="double">Double</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1771028478271" rule="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"/>&#13;
		<field type="header" subtype="h3" label="Primary Guest"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#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 (nickname)" 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" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Secondary Guest"/>&#13;
		<field type="text" label="Secondary Guest Prefix" name="secondary-guest-prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Secondary Guest First name" name="secondary-guest-first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Secondary Guest Middle name" name="secondary-guest-middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Secondary Guest Last name" name="secondary-guest-last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Secondary Guest Suffix" name="secondary-guest-suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Secondary Guest Preferred name" name="secondary-guest-preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Primary Guest Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Important Dates"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="date" label="Secondary Guest Birthday" name="secondary-guest-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;
			<option label="X" value="xOther">X</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Secondary Guest Gender" name="radio-group-1771028719379">&#13;
			<option label="F" value="Female">F</option>&#13;
			<option label="M" value="Male">M</option>&#13;
			<option label="X" value="Other">X</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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