Share your information with Pamela King

Pamela King

Blendz Travels

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Be the first to know where Blendz Travels is going next."/>&#13;
		<field type="paragraph" subtype="p" label="Join the Blendz Travel List for upcoming trips, first-access opportunities, payment plan announcements, and curated travel experiences designed for women ready to choose joy."/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="select" label="What type of travel experiences are you most interested in?" name="select-1783534884369" multiple="multiple" className="form-control">&#13;
			<option label="One-day trips" value="oneday-trips">One-day trips</option>&#13;
			<option label="Weekend getaways" value="weekend-getaways">Weekend getaways</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Wine Trips" value="wine-trips">Wine Trips</option>&#13;
			<option label="Shopping Escapes" value="shopping-escapes">Shopping Escapes</option>&#13;
			<option label="International Trips" value="international-trips">International Trips</option>&#13;
			<option label="Celebration Trips" value="celebration-trips">Celebration Trips</option>&#13;
			<option label="Day Trips" value="day-trips">Day Trips</option>&#13;
			<option label="I'm open just keep me posted" value="im-open-just-keep-me-posted">I'm open just keep me posted</option>&#13;
		</field>&#13;
		<field type="select" label="How do you usually travel?&amp;nbsp;" name="select-1783535345966" multiple="multiple" className="form-control">&#13;
			<option label="Solo" value="solo">Solo</option>&#13;
			<option label="With a friend" value="with-a-friend">With a friend</option>&#13;
			<option label="With my spouse/partner" value="with-my-spousepartner">With my spouse/partner</option>&#13;
			<option label="With a group" value="with-a-group">With a group</option>&#13;
			<option label="I haven't traveled much, but I'm ready" value="i-havent-traveled-much-but-im-ready">I haven't traveled much, but I'm ready</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes you right now?&amp;nbsp;" name="radio-group-1783535437361">&#13;
			<option label="I'm ready to book something soon" value="im-ready-to-book-something-soon">I'm ready to book something soon</option>&#13;
			<option label="I'm interested, but I need details first" value="im-interested-but-i-need-details-first">I'm interested, but I need details first</option>&#13;
			<option label="I'm just joining the list for future trips" value="im-just-joining-the-list-for-future-trips">I'm just joining the list for future trips</option>&#13;
			<option label="I want to invite friends/family" value="i-want-to-invite-friendsfamily">I want to invite friends/family</option>&#13;
		</field>&#13;
		<field type="textarea" label="Anything you want Blendz Travels to know?&amp;nbsp;" name="textarea-1783535513067" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>