NOLA Live Cruise

<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" label="Suffix" name="suffix" 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="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="checkbox-group" required="true" label="Have you make a previous payment" inline="true" name="checkbox-group-1736264350541">&#13;
			<option label="Yes" value="">Yes</option>&#13;
			<option label="No" value="">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="How many people traveling&amp;nbsp;" inline="true" name="how-many-people-traveling-">&#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;
		</field>&#13;
		<field type="radio-group" required="true" label="Select Your Room" inline="true" name="select-your-room">&#13;
			<option label="Interior Cabin" value="interior-cabin">Interior Cabin</option>&#13;
			<option label="Ocean View Cabin" value="ocean-view-cabin">Ocean View Cabin</option>&#13;
			<option label="Balcony Cabin" value="balcony-cabin">Balcony Cabin</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Add a Nola Live T-Shrit" inline="true" name="add-a-nola-live-tshrit">&#13;
			<option label="S" value="s">S</option>&#13;
			<option label="M" value="m">M</option>&#13;
			<option label="L" value="l">L</option>&#13;
			<option label="1X" value="1x">1X</option>&#13;
			<option label="2X" value="2x">2X</option>&#13;
			<option label="3X" value="3x">3X</option>&#13;
			<option label="4X" value="4x">4X</option>&#13;
			<option label="5X" value="5x">5X</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>