Share your information with Harley Petrin

Harley Petrin

Travelmation

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Annual Veterans Cruise — Cabin Request Form"/>&#13;
		<field type="paragraph" subtype="p" label="Thank you for joining our Annual Veterans Cruise! Please complete one form per cabin. This form collects the basic information needed to request your cabin, coordinate roommates, and communicate important cruise details.  Please enter all names exactly as they appear on each guests government-issued ID/passport."/>&#13;
		<field type="header" subtype="h3" label="Lead Guest"/>&#13;
		<field type="text" required="true" label="First name" placeholder="First" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" placeholder="Middle" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" placeholder="Last" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred Name" description="What would you like us to call you?" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of Birth" name="birthday" className="form-control"/>&#13;
		<field type="text" subtype="tel" required="true" label="Phone Number" name="phone-number" className="form-control"/>&#13;
		<field type="text" subtype="email" required="true" label="Email Address" name="email" className="form-control"/>&#13;
		<field type="text" required="true" label="Mailing Address" description="Street Address  City  State  ZIP Code" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Veteran Information"/>&#13;
		<field type="radio-group" required="true" label="Are you a Veteran? (Don&#39;t worry, you do not have to be to join!)" name="veteran-status" className="radio-group">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Traveling with a Veteran" value="traveling-with-veteran">Traveling with a Veteran</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Cruise Line &amp;amp; Cabin Request"/>&#13;
		<field type="select" label="Have you sailed with Norwegian Cruise Line before?" name="select-1785872221453" className="form-control">&#13;
			<option label="Yes, I have a Latitudes Rewards #" value="yes-i-have-a-latitudes-rewards-">Yes, I have a Latitudes Rewards #</option>&#13;
			<option label="No, This is my first time with Norwegian" value="no-this-is-my-first-time-with-norwegian">No, This is my first time with Norwegian</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="How many guests will be staying in your cabin?" name="number-of-travelers" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Preferred Cabin Type" name="preferred-cabin-type" className="radio-group">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
		</field>&#13;
		<field type="select" label="Do you want to include the optional Trip protection?" name="select-1785873090760" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Maybe" value="maybe">Maybe</option>&#13;
		</field>&#13;
		<field type="select" label="Do you want to include optional Service Charges?" description="(cabin crew  entertainment  main dining)" name="select-1785873116833" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Maybe" value="maybe">Maybe</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="Note: Cabin type is requested but cannot be guaranteed until the reservation is confirmed."/>&#13;
		<field type="radio-group" label="Preferred Cabin Location" name="preferred-cabin-location" className="radio-group">&#13;
			<option label="Forward" value="forward">Forward</option>&#13;
			<option label="Midship" value="midship">Midship</option>&#13;
			<option label="Aft" value="aft">Aft</option>&#13;
			<option label="No Preference" value="no-preference">No Preference</option>&#13;
		</field>&#13;
		<field type="textarea" label="Do you have a specific cabin or location request?" description="Please provide any specific cabin/location requests." name="specific-cabin-location-request" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Roommate Information"/>&#13;
		<field type="text" label="Roommate #2 1 Full Legal Name" description="Please enter their name exactly as it appears on their government-issued ID/passport." name="roommate-2-full-legal-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Roommate #2 Date Of Birth" name="date-1785871648137" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are you requesting to be near another cabin/group member?" name="request-near-group-member" className="radio-group">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="Name(s) of the guest(s) you would like to be near" description="Please list their full names." name="guests-to-be-near" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="ACCESSIBILITY &amp;amp; SPECIAL NEEDS"/>&#13;
		<field type="radio-group" required="true" label="Does anyone in your cabin have accessibility or mobility needs?" name="cabin-accessibility-needs" other="true" className="radio-group">&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What equipment or assistance will be needed?" name="equipment-assistance-needed" other="true" className="checkbox-group">&#13;
			<option label="Wheelchair" value="wheelchair">Wheelchair</option>&#13;
			<option label="Mobility scooter" value="mobility-scooter">Mobility scooter</option>&#13;
			<option label="Walker" value="walker">Walker</option>&#13;
			<option label="Cane" value="cane">Cane</option>&#13;
			<option label="CPAP" value="cpap">CPAP</option>&#13;
			<option label="Other medical/travel equipment" value="other-medical-travel-equipment">Other medical/travel equipment</option>&#13;
		</field>&#13;
		<field type="textarea" label="Please provide any accessibility information we should know." description="Please do not include unnecessary medical information. Tell us only what is needed to help us coordinate your cruise accommodations." name="accessibility-information" className="form-control"/>&#13;
		<field type="text" label="Emergency Contact 1 Full Name" name="emergency-contact" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Relationship to Guest" name="emergency-contact-relationship" subtype="text" className="form-control"/>&#13;
		<field type="text" subtype="tel" label="Emergency Contact Phone Number" name="emergency-contact-phone" className="form-control"/>&#13;
		<field type="textarea" label="Do you have any additional cabin or cruise requests?" name="additional-cabin-cruise-requests" className="form-control"/>&#13;
		<field type="textarea" label="Is there anything else your Travel Advisor should know?" name="travel-advisor-notes" className="form-control"/>&#13;
		<field type="header" subtype="h3" label=" THANK YOU FOR YOUR SERVICE!"/>&#13;
		<field type="paragraph" subtype="p" label="We are honored to have you join us for our 4th Annual Veterans Cruise &amp;amp; if this is your first one, Welcome! Once your form is submitted, we will review your request and follow up regarding cabin availability, pricing, and next steps."/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>