Share your information with Satina Horne & Jamar Boykins

Satina Horne & Jamar Boykins

The S&J Travel Experience

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#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" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Airport Departing From" name="airport-departing-from" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Information"/>&#13;
		<field type="text" required="true" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="radio-group" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
			<option label="X" value="other">X</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Room Category&amp;nbsp; -&amp;nbsp; The Riu Palace Baja California - Adults Only&amp;nbsp;" name="room-category">&#13;
			<option label="Junior Suite Courtyard View" value="Junior Suite Courtyard View">Junior Suite Courtyard View</option>&#13;
			<option label="Junior Suite Partial Oceanview " value="Junior Suite Partial Oceanview ">Junior Suite Partial Oceanview </option>&#13;
			<option label="Junior Suite Ocean Front - Elite Club" value="Junior Suite Ocean Front - Elite Club">Junior Suite Ocean Front - Elite Club</option>&#13;
			<option label="Suite Ocean Front - Elite Club" value="Suite Ocean Front - Elite Club">Suite Ocean Front - Elite Club</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Flight&amp;nbsp;" name="flight-category-">&#13;
			<option label="Main Cabin" value="main-cabin">Main Cabin</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Number of Days" name="number-of-days">&#13;
			<option label="6Days/5Nights" value="6days5nights">6Days/5Nights</option>&#13;
			<option label="5Days/4Nights " value="5days4nights-">5Days/4Nights </option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Roommate Name- If booking single put N/A" name="roommate-name-if-booking-single-put-na" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="TSA PreCheck- N/A if not available&amp;nbsp;" name="tsa-precheck-na-if-not-available-" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Global Entry Number/KTN- N/A if not available&amp;nbsp;" name="global-entry-numberktn-na-if-not-available-" className="form-control"/>&#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="header" subtype="h1" label="Emergency Contact Information&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Name&amp;nbsp;" name="name-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Telephone Number" name="telephone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Insurance"/>&#13;
		<field type="checkbox-group" required="true" label="Please choose:" name="please-choose">&#13;
			<option label="I WILL get  travel insurance on my own and protect my  travel cost" value="i-will-get-travel-insurance-on-my-own-and-protect-my-travel-cost">I WILL get  travel insurance on my own and protect my  travel cost</option>&#13;
			<option label="I DECLINE travel insurance. I understand that this could result in the loss of ALL of my travel costs." value="i-decline-travel-insurance-i-understand-that-this-could-result-in-the-loss-of-all-of-my-travel-costs">I DECLINE travel insurance. I understand that this could result in the loss of ALL of my travel costs.</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>