Share your information with Laura Varnau

Laura Varnau

LV Virtual Solutions

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Info"/>&#13;
		<field type="text" required="true" label="First name" name="first-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="Preferred name" name="preferred-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" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Trip Details"/>&#13;
		<field type="checkbox-group" required="true" label="Where are you interested in cruising to?" name="what-destinations-are-you-interested-in" other="true">&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
		</field>&#13;
		<field type="date" label="When would you like to go? Leave blank if you don&#39;t have any specific travel dates in mind." name="when-would-you-like-to-go-leave-blank-if-you-dont-have-any-specific-travel-dates-in-mind" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are your dates flexible?" name="are-your-dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="How many travelers will be in your group, including yourself?" name="how-many-travelers-will-be-in-your-group-including-yourself">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="More than 5" value="more-than-5">More than 5</option>&#13;
		</field>&#13;
		<field type="text" label="If you are traveling with children, what will their ages be at the time of travel?" name="if-you-are-traveling-with-children-what-will-their-ages-be-at-the-time-of-travel" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Where are you in the planning process?" name="where-are-you-in-the-planning-process" other="true">&#13;
			<option label="I have an idea of where I'd like to go but I'm not sure which cruise line" value="i-have-an-idea-of-where-id-like-to-go-but-im-not-sure-which-cruise-line">I have an idea of where I'd like to go but I'm not sure which cruise line</option>&#13;
			<option label="I have a specific cruise in mind" value="i-have-a-specific-cruise-in-mind">I have a specific cruise in mind</option>&#13;
			<option label="I have no idea what I'm doing and need some help" value="i-have-no-idea-what-im-doing-and-need-some-help">I have no idea what I'm doing and need some help</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>