<form-template>
	<fields>
		<field type="header" subtype="h1" label="Please fill in the changes you would like to make here"/>
		<field type="header" subtype="h2" label="Full name"/>
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>
		<field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>
		<field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/>
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>
		<field type="radio-group" label="Transportation" name="radio-group-1637521024554">
			<option label="Prefer to book on my own" value="prefer-to-book-on-my-own">Prefer to book on my own</option>
			<option label="Prefer Private Transfer" value="prefer-private-transfer">Prefer Private Transfer</option>
			<option label="Prefer Car rental" value="prefer-car-rental">Prefer Car rental</option>
			<option label="Prefer Shared Transportation" value="prefer-shared-transportation">Prefer Shared Transportation</option>
		</field>
		<field type="textarea" label="Provide more details here about transportation changes" name="provide-more-details-here-about-transportation-changes" className="form-control"/>
		<field type="radio-group" label="Hotels" name="radio-group-1637521026075">
			<option label="Prefer Upgrade same hotel" value="prefer-upgrade-same-hotel">Prefer Upgrade same hotel</option>
			<option label="Prefer Downgrade same hotel" value="prefer-downgrade-same-hotel">Prefer Downgrade same hotel</option>
			<option label="Prefer Upgrade different hotel" value="prefer-upgrade-different-hotel">Prefer Upgrade different hotel</option>
			<option label="Prefer downgrade different hotel" value="prefer-downgrade-different-hotel">Prefer downgrade different hotel</option>
		</field>
		<field type="text" label="Please provide more information on hotel changes" name="please-provide-more-information-on-hotel-changes" subtype="text" className="form-control"/>
		<field type="radio-group" label="Destination" name="radio-group-1637521026927">
			<option label="I would like a similar less expensive destination" value="i-would-like-a-similar-less-expensive-destination">I would like a similar less expensive destination</option>
			<option label="I would like to upgrade to a different destination" value="i-would-like-to-upgrade-to-a-different-destination">I would like to upgrade to a different destination</option>
		</field>
		<field type="text" label="I want to change my dates. Please provide detail on the date changes needed.&amp;nbsp;" name="i-want-to-change-my-dates-please-provide-detail-on-the-date-changes-needed-" subtype="text" className="form-control"/>
		<field type="text" label="Provide more info on changes to detination here" name="provide-more-info-on-changes-to-detination-here" subtype="text" className="form-control"/>
		<field type="text" label="Please provide info on other changes you wouldlike to make here" name="please-provide-info-on-other-changes-you-wouldlike-to-make-here" subtype="text" className="form-control"/>
	</fields>
</form-template>