Share your information with Cheryl Cooper

Cheryl Cooper

Élevé Experiences Travel Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Group Cruise"/>&#13;
		<field type="radio-group" required="true" label="Group Cruise Quote Request" description="Please select which group cruise for your quote" name="group-cruise-quote-request" other="true">&#13;
			<option label="NCL EPIC Solo Group Cruise 2026" value="ncl-epic-solo-group-cruise-2026">NCL EPIC Solo Group Cruise 2026</option>&#13;
			<option label="ULTIMATE Solo Group Cruise 2026" value="ultimate-solo-group-cruise-2026">ULTIMATE Solo Group Cruise 2026</option>&#13;
			<option label="EXPLORA II Caribbean Opulence Cruise 2026" value="explora-ii-caribbean-opulence-cruise-2026">EXPLORA II Caribbean Opulence Cruise 2026</option>&#13;
			<option label="EXPLORA III Caribbean Opulence Cruise 2027" value="explora-iii-caribbean-opulence-cruise-2027">EXPLORA III Caribbean Opulence Cruise 2027</option>&#13;
			<option label="ULTIMATE Land and Sea 2027" value="ultimate-land-and-sea-2027">ULTIMATE Land and Sea 2027</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Traveler Information"/>&#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="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="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="text" required="true" label="Primary phone number" name="phone-number" 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="header" subtype="h2" label="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" 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" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Discounts" description="Please select any that apply:" name="discounts" multiple="multiple" className="form-control">&#13;
			<option label="Military" value="military">Military</option>&#13;
			<option label="55+" value="55">55+</option>&#13;
			<option label="Florida" value="florida">Florida</option>&#13;
			<option label="Healthcare" value="healthcare">Healthcare</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Include Gratuities?" description="Would you like to include gratuities now or take care of them later?" name="include-gratuities">&#13;
			<option label="Yes, please add in gratuities now" value="yes-please-add-in-gratuities-now">Yes, please add in gratuities now</option>&#13;
			<option label="No, I will take care of gratuities later" value="no-i-will-take-care-of-gratuities-later">No, I will take care of gratuities later</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Will you use a valid passport or state issued birth certificate for travel?" description="Please select one" name="will-you-use-a-valid-passport-or-state-issued-birth-certificate-for-travel">&#13;
			<option label="Valid Passport" value="valid-passport">Valid Passport</option>&#13;
			<option label="Official State-Issued Birth Certificate" value="official-stateissued-birth-certificate">Official State-Issued Birth Certificate</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Travel Insurance Waiver" description="Select to acknowledge the option to purchase travel insurance" name="travel-insurance-waiver">&#13;
			<option label="I will purchase and protect my trip with travel insurance later" value="i-will-purchase-and-protect-my-trip-with-travel-insurance-later">I will purchase and protect my trip with travel insurance later</option>&#13;
			<option label="I decline to purchase travel insurance to protect my trip" value="i-decline-to-purchase-travel-insurance-to-protect-my-trip">I decline to purchase travel insurance to protect my trip</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Additional Travelers"/>&#13;
		<field type="text" label="Additional Travelers Information" description="Please list additional travelers and their birthdates for quote" name="additional-travelers-information" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="radio-group" required="true" label="Cabin Type" inline="true" name="cabin-type" other="true">&#13;
			<option label="Solo Studio (NCL Only)" value="solo-studio-ncl-only">Solo Studio (NCL Only)</option>&#13;
			<option label="Solo Interior (if available)" value="solo-interior-if-available">Solo Interior (if available)</option>&#13;
			<option label="Solo Ocean View (if available)" value="solo-ocean-view-if-available">Solo Ocean View (if available)</option>&#13;
			<option label="Solo Balcony (if available)" value="solo-balcony-if-available">Solo Balcony (if available)</option>&#13;
			<option label="Interior Cabin" value="interior-cabin">Interior Cabin</option>&#13;
			<option label="Ocean View Cabin (if available)" value="ocean-view-cabin-if-available">Ocean View Cabin (if available)</option>&#13;
			<option label="Balcony/Verandah Cabin" value="balconyverandah-cabin">Balcony/Verandah Cabin</option>&#13;
			<option label="Explora Journeys Ocean Terrace Suite" value="explora-journeys-ocean-terrace-suite">Explora Journeys Ocean Terrace Suite</option>&#13;
			<option label="Explora Journeys Ocean Grand Terrace Suite" value="explora-journeys-ocean-grand-terrace-suite">Explora Journeys Ocean Grand Terrace Suite</option>&#13;
			<option label="Explora Journeys Ocean Residence" value="explora-journeys-ocean-residence">Explora Journeys Ocean Residence</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your preferred dining time?" description="Please select one" name="hotel-preference">&#13;
			<option label="Early Dining 6:00 PM" value="early-dining-600-pm">Early Dining 6:00 PM</option>&#13;
			<option label="Late Dining 8:00 PM" value="late-dining-800-pm">Late Dining 8:00 PM</option>&#13;
			<option label="Any Time Dining 5:30 PM - 9:00 PM" value="any-time-dining-530-pm-900-pm">Any Time Dining 5:30 PM - 9:00 PM</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Additional Information"/>&#13;
		<field type="checkbox-group" required="true" label="Cruise Lines Previously Sailed" description="Please select cruises lines you have sailed" name="cruise-lines-previously-sailed" other="true">&#13;
			<option label="None" value="none">None</option>&#13;
			<option label="Carnival" value="carnival">Carnival</option>&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="NCL" value="ncl">NCL</option>&#13;
			<option label="MSC" value="msc">MSC</option>&#13;
			<option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option>&#13;
			<option label="Princess" value="princess">Princess</option>&#13;
			<option label="Holland America" value="holland-america">Holland America</option>&#13;
			<option label="Celebrity" value="celebrity">Celebrity</option>&#13;
			<option label="Disney" value="disney">Disney</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Email List Signup" description="Would you like to receive information on deals  promotions  solo and group bookings  etc.?" name="email-list-signup">&#13;
			<option label="Yes, please notify me of group cruises, deals, promos, etc." value="yes-please-notify-me-of-group-cruises-deals-promos-etc">Yes, please notify me of group cruises, deals, promos, etc.</option>&#13;
			<option label="Not at this time" value="not-at-this-time">Not at this time</option>&#13;
		</field>&#13;
		<field type="text" label="Notes" description="Please include any additional information you would like to share" name="notes" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>