<html> <body> <form-template> <fields> <field type="text" required="true" label="First name" placeholder="Please enter your name exactly as it appears on your government issued ID as later changes could incur extra costs. Passport is recommended." name="first-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="date" label="Birthday" name="birthday" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="checkbox-group" label="This is a mobile number" name="this-is-a-mobile-number"> <option label="Yes" value="yes">Yes</option> </field> <field type="radio-group" required="true" label="What is your budget for you cruise (total, for all travelers)" name="what-is-your-budget-for-you-cruise-total-for-all-travelers" other="true"> <option label="$500-1000" value="5001000">$500-1000</option> <option label="$1001-1500" value="10011500">$1001-1500</option> <option label="$1501-2500" value="15012500">$1501-2500</option> <option label="$2501-4500" value="25014500">$2501-4500</option> <option label="$4501-6500" value="45016500">$4501-6500</option> <option label="$6501-8500" value="65018500">$6501-8500</option> <option label="$8501-10,000" value="850110000">$8501-10,000</option> <option label="$10,000+" value="10000">$10,000+</option> </field> <field type="date" required="true" label="What date would you like to sail?&nbsp;" name="what-date-would-you-like-to-sail-" className="form-control"/> <field type="radio-group" required="true" label="Is this date flexible?" name="is-this-date-flexible"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" required="true" label="Cruise length" name="cruise-length"> <option label="2-5 days" value="25-days">2-5 days</option> <option label="6-9 days" value="69-days">6-9 days</option> <option label="10+ days" value="10-days">10+ days</option> </field> <field type="textarea" required="true" label="Please enter names and birthdates of all additional members of those traveling with you" placeholder="Make sure this information matches their government-issued photo ID exactly as later changes could incur extra costs. Passport may not be required for your cruise but is recommended. If you have submitted birthdates previously please type "On File"" name="please-enter-names-and-birthdates-of-your-traveling-party" className="form-control"/> <field type="checkbox-group" required="true" label="Cruise Line(s) you're interested in:" name="cruise-lines" other="true"> <option label="I'm not sure, or I'm a first-time cruiser. Send me the Cruise Line Qualifier form." value="im-not-sure-or-im-a-firsttime-cruiser-send-me-the-cruise-line-qualifier-form">I'm not sure, or I'm a first-time cruiser. Send me the Cruise Line Qualifier form.</option> <option label="Carnival" value="carnival">Carnival</option> <option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option> <option label="Norwegian" value="norwegian">Norwegian</option> <option label="Princess" value="princess">Princess</option> <option label="Holland America" value="holland-america">Holland America</option> <option label="Celebrity" value="celebrity">Celebrity</option> <option label="Disney" value="disney">Disney</option> <option label="MSC" value="msc">MSC</option> <option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option> <option label="Margaritaville at Sea" value="margaritaville-at-sea">Margaritaville at Sea</option> <option label="Viking" value="viking">Viking</option> <option label="American Cruise Lines" value="american-cruise-lines">American Cruise Lines</option> </field> <field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/> <field type="text" required="true" label="How many cabins will your party need?" name="how-many-cabins-will-your-party-need" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Sail From:" name="sail-from" other="true"> <option label="Jacksonville" value="jacksonville">Jacksonville</option> <option label="Port Canaveral" value="port-canaveral">Port Canaveral</option> <option label="Tampa" value="tampa">Tampa</option> <option label="Fort Lauderdale" value="fort-lauderdale">Fort Lauderdale</option> <option label="Miami" value="miami">Miami</option> <option label="Charleston" value="charleston">Charleston</option> <option label="Mobile" value="mobile">Mobile</option> <option label="New Orleans" value="new-orleans">New Orleans</option> <option label="West Coast" value="west-coast">West Coast</option> <option label="Canada" value="canada">Canada</option> </field> <field type="checkbox-group" required="true" label="Sail to:" name="sail-to" other="true"> <option label="Bahamas" value="bahamas">Bahamas</option> <option label="Eastern Caribbean" value="eastern-caribbean">Eastern Caribbean</option> <option label="Western Caribbean" value="western-caribbean">Western Caribbean</option> <option label="Alaska" value="alaska">Alaska</option> <option label="Hawaii" value="hawaii">Hawaii</option> <option label="Panama Canal" value="panama-canal">Panama Canal</option> <option label="Transatlantic" value="transatlantic">Transatlantic</option> <option label="Asia" value="asia">Asia</option> <option label="South Pacific" value="south-pacific">South Pacific</option> <option label="Transpacific" value="transpacific">Transpacific</option> <option label="River" value="river">River</option> </field> <field type="text" label="Any Particular Ports of Interest?&nbsp;" name="any-particular-ports-of-interest-" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Preferred Ship Area" inline="true" name="preferred-ship-area"> <option label="Forward" value="forward">Forward</option> <option label="Mid" value="mid">Mid</option> <option label="Aft" value="aft">Aft</option> <option label="Port" value="port">Port</option> <option label="Starboard" value="starboard">Starboard</option> </field> <field type="checkbox-group" required="true" label="Cabin Type" inline="true" name="cabin-type" other="true"> <option label="Upper/Lower" value="upperlower">Upper/Lower</option> <option label="Interior" value="interior">Interior</option> <option label="Ocean View" value="ocean-view">Ocean View</option> <option label="Balcony" value="balcony">Balcony</option> <option label="Suite" value="suite">Suite</option> <option label="Mobility/Accessible" value="mobilityaccessible">Mobility/Accessible</option> </field> <field type="checkbox-group" required="true" label="Are you interested in excursions?" name="are-you-interested-in-excursions" other="true"> <option label="Adventure" value="adventure">Adventure</option> <option label="Local Culture/Arts" value="local-culturearts">Local Culture/Arts</option> <option label="Food & Wine" value="food-wine">Food & Wine</option> <option label="Family Friendly" value="family-friendly">Family Friendly</option> <option label="Beach" value="beach">Beach</option> <option label="Watersports" value="watersports">Watersports</option> <option label="Sightseeing/Tours" value="sightseeingtours">Sightseeing/Tours</option> <option label="No excursions" value="no-excursions">No excursions</option> </field> <field type="radio-group" required="true" label="Preferred Dining Time (if applicable)" name="preferred-dining-time-if-applicable"> <option label="Early Seating (usually 5:00-5:30 pm)" value="early-seating-usually-500530-pm">Early Seating (usually 5:00-5:30 pm)</option> <option label="Late Seating (usually 7:30-8:00 pm)" value="late-seating-usually-730800-pm">Late Seating (usually 7:30-8:00 pm)</option> <option label="Any time/My time Dining (arrive at any time during a set meal time period)" value="any-timemy-time-dining-arrive-at-any-time-during-a-set-meal-time-period">Any time/My time Dining (arrive at any time during a set meal time period)</option> </field> <field type="radio-group" required="true" label="Would you like to pre-pay gratuities (if applicable)?" inline="true" name="would-you-like-to-prepay-gratuities-if-applicable"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="radio-group" required="true" label="Will you need flights to/from port?" inline="true" name="will-you-need-flights-tofrom-port"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" required="true" label="Will you need a pre- or post-cruise hotel?" inline="true" name="will-you-need-a-pre-or-postcruise-hotel"> <option label="No" value="no">No</option> <option label="Yes, pre-cruise" value="yes-precruise">Yes, pre-cruise</option> <option label="Yes, post-cruise" value="yes-postcruise">Yes, post-cruise</option> </field> <field type="radio-group" required="true" label="What is your COVID-19 Vaccination Status?" name="what-is-your-covid19-vaccination-status" other="true"> <option label="All travelers are unvaccinated" value="all-travelers-are-unvaccinated">All travelers are unvaccinated</option> <option label="All Travelers are Fully Vaccinated (including at least 1 booster)" value="all-travelers-are-fully-vaccinated-including-at-least-1-booster">All Travelers are Fully Vaccinated (including at least 1 booster)</option> <option label="All Travelers are vaccinated without booster" value="all-travelers-are-vaccinated-without-booster">All Travelers are vaccinated without booster</option> <option label="Adults are fully vaccinated with booster(s), children are unvaccinated" value="adults-are-fully-vaccinated-with-boosters-children-are-unvaccinated">Adults are fully vaccinated with booster(s), children are unvaccinated</option> <option label="Adults are vaccinated without booster, children are unvaccinated" value="adults-are-vaccinated-without-booster-children-are-unvaccinated">Adults are vaccinated without booster, children are unvaccinated</option> </field> <field type="checkbox-group" required="true" label="Will you be celebrating on this cruise?" inline="true" name="will-you-be-celebrating-on-this-cruise" other="true"> <option label="No Celebration" value="no-celebration">No Celebration</option> <option label="Honeymoon" value="honeymoon">Honeymoon</option> <option label="Birthday" value="birthday">Birthday</option> <option label="Anniversary" value="anniversary">Anniversary</option> <option label="Retirement" value="retirement">Retirement</option> <option label="Family/Class Reunion" value="familyclass-reunion">Family/Class Reunion</option> </field> <field type="textarea" required="true" label="Do any members of your traveling party have special dietary, mobility, or medical needs? If yes, please list below." name="do-any-members-of-your-traveling-party-have-special-dietary-mobility-or-medical-needs-if-yes-please-list-below" className="form-control"/> <field type="text" required="true" label="Emergency Contact Name, Relationship, and Phone Number" placeholder="Provide an Emergency Contact that is not going on the cruise with you. This information will only be used to satisfy cruise line requirements." name="emergency-contact-name-relationship-and-phone-number" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="I have the authority and permission to oversee travel arrangements and agreements for each member of my traveling party.&nbsp;" inline="true" name="i-have-the-authority-and-permission-to-oversee-travel-arrangements-and-agreements-for-each-member-of-my-traveling-party-"> <option label="Yes" value="yes">Yes</option> </field> <field type="checkbox-group" required="true" label="Preferred method of communication" inline="true" name="preferred-method-of-communication" other="true"> <option label="Text" value="text">Text</option> <option label="Facebook Messenger" value="facebook-messenger">Facebook Messenger</option> <option label="Email" value="email">Email</option> <option label="Phone Call" value="phone-call">Phone Call</option> </field> <field type="radio-group" required="true" label="I agree to receive email and snail mail marketing" name="i-agree-to-receive-email-and-snail-mail-marketing"> <option label="Yes" value="yes" selected="selected">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h1" label="Proposals often end up in your spam folder, especially if it's the first email you get from me. Please add rena@latitudetravelplanning.com to your email address book/whitelist to ensure that you receive all messages from me. Thanks!"/> </fields> </form-template> </body> </html>
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