Share your information with Scott Davis

Scott Davis

Your EPIC Vacation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full Name as it Appears on your License / Passport"/>&#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="Preferred Name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Sex" name="radio-group-1775870191075">&#13;
			<option label="Male" value="male">Male</option>&#13;
			<option label="Female" value="female">Female</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="text" required="true" label="Cell Phone Number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="date" label="Wedding Anniversary" name="wedding-anniversary" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" 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" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" 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;
	</fields>&#13;
</form-template>
  </body>
</html>