Share your information with Chelsea Nash

Chelsea Nash

Think of a Wonderful Trip

<html>
  <body>
    <form-template>&#13;
	<fields>&#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" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" 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" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Questions concerning your sailing"/>&#13;
		<field type="checkbox-group" required="true" label="What destination do you have in mind?" name="what-destination-do-you-have-in-mind" other="true">&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Asia" value="asia">Asia</option>&#13;
			<option label="Australia" value="australia">Australia</option>&#13;
			<option label="Bahamas" value="bahamas">Bahamas</option>&#13;
			<option label="Bermuda" value="bermuda">Bermuda</option>&#13;
			<option label="Canada &amp; New England" value="canada-new-england">Canada &amp; New England</option>&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="Hawaii" value="hawaii">Hawaii</option>&#13;
			<option label="Mediterranean" value="mediterranean">Mediterranean</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Do you have a Cruiseline in mind?" name="do-you-have-a-cruiseline-in-mind" other="true">&#13;
			<option label="Carnival" value="carnival">Carnival</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="MSC" value="msc">MSC</option>&#13;
			<option label="Norwegian" value="norwegian">Norwegian</option>&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option>&#13;
		</field>&#13;
		<field type="date" required="true" label="When would you like to depart?" name="when-would-you-like-to-depart" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" name="when-would-you-like-to-return" className="form-control"/>&#13;
		<field type="text" label="Are your dates flexible?" name="are-your-dates-flexible" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Will you be flying? If so, please give departure airport." name="will-you-be-flying-if-so-please-give-departure-airport" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many travelers?" name="how-many-travelers" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Your Birthday" name="your-birthday" className="form-control"/>&#13;
		<field type="textarea" required="true" label="List other adult&#39;s names with birthdates traveling" name="list-other-adults-names-with-birthdates-traveling" className="form-control"/>&#13;
		<field type="textarea" required="true" label="List children&#39;s names with birthdates traveling" name="list-childrens-names-with-birthdates-traveling" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Preferences"/>&#13;
		<field type="text" required="true" label="What is your preferred budget?" name="what-is-your-preferred-budget" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Do you have a cabin category preference?" name="do-you-have-a-cabin-category-preference" other="true">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Verandah / Balcony" value="verandah-balcony">Verandah / Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Which area of the ship do you prefer?" name="which-area-of-the-ship-do-you-prefer">&#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="text" label="Port side or Starboard Side?" name="port-side-or-starboard-side" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Are you celebrating anything special?" name="are-you-celebrating-anything-special" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="What atmosphere are you hoping for?" name="what-atmosphere-are-you-hoping-for" other="true">&#13;
			<option label="Adults Only" value="adults-only">Adults Only</option>&#13;
			<option label="Relaxing" value="relaxing">Relaxing</option>&#13;
			<option label="Party / Nightlife" value="party-nightlife">Party / Nightlife</option>&#13;
			<option label="Family Friendly" value="family-friendly">Family Friendly</option>&#13;
		</field>&#13;
		<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"/>&#13;
		<field type="textarea" label="What else would you like me to know?" name="what-else-would-you-like-me-to-know" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>