Cheryl Cooper

Travel with SIG

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    <form-template>&#13;
	<fields>&#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="date" required="true" label="Birthdate" name="birthdate" 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="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="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;
		</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" 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" value="solo-interior">Solo Interior</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" value="solo-balcony">Solo Balcony</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 Cabin" value="balcony-cabin">Balcony Cabin</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="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>