Share your information with Jill Canning

Jill Canning

Jill Beth Travel

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Traveler Information&amp;nbsp;"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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="radio-group" required="true" label="Are you interested in going on the Windstar Dreams of Tahiti trip?&amp;nbsp;" name="are-you-interested-in-going-on-the-windstar-dreams-of-tahiti-trip-">&#13;
			<option label="Strong yes, would like details, please " value="strong-yes-would-like-details-please-">Strong yes, would like details, please </option>&#13;
			<option label="Maybe, please send details " value="maybe-please-send-details-">Maybe, please send details </option>&#13;
		</field>&#13;
		<field type="radio-group" label="Will you have companion(s) traveling with you on the Tahiti cruise?&amp;nbsp;" name="will-you-have-a-companion-traveling-with-you-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Please provide Full Names of your companion (and ages if children)&amp;nbsp;" name="please-provide-full-name-of-your-companion" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How did you hear about this cruise?&amp;nbsp;" name="how-did-you-hear-about-this-cruise-" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Have you been to Tahiti before?&amp;nbsp;" name="have-you-been-to-tahiti-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No " value="no-">No </option>&#13;
		</field>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Add any questions you have here!" name="textarea-1585536114234" className="form-control"/>&#13;
	</fields>&#13;
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