Tracy Ballagh

Faugh A Ballagh Travel

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	<fields>&#13;
		<field type="header" subtype="h1" label="WELCOME to FAUGH a BALLAGH TRAVEL"/>&#13;
		<field type="header" subtype="h1" label="THANK YOU for your interest in learning more about this amazing AMAWaterways River Cruise. &amp;nbsp;Please complete this form and I will be in touch."/>&#13;
		<field type="paragraph" subtype="p" label="----------------"/>&#13;
		<field type="paragraph" subtype="p" label="COUNTRIES: FRANCE"/>&#13;
		<field type="paragraph" subtype="p" label="Discover the most renowned sites in Paris as well as sites memorialized by famous Impressionist painters along France’s Seine River. Meander through the renowned Gardens d’Acquigny and visit Monet’s home and gardens in Giverny. Indulge in Norman chocolate, cheese and cider and enhance your best self on guided bike tours through charming cities like Le Havre and Rouen. With fairytale castles, châteaux and idyllic scenery at every turn, this cruise is sure to inspire your own art – or at least conjure beautiful memories and dreams for years to come!"/>&#13;
		<field type="paragraph" subtype="p" label="----------------"/>&#13;
		<field type="paragraph" subtype="p" label="CRUISE FROM: PARIS TO LE HAVRE"/>&#13;
		<field type="paragraph" subtype="p" label="RIVERS: Seine"/>&#13;
		<field type="header" subtype="h2" label="Full name&amp;nbsp;"/>&#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" label="Preferred name" name="preferred-name" 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 required="true"  type="text" 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="Important Dates"/>&#13;
		<field type="date" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="What Cabin Category are you interested in?"/>&#13;
		<field type="radio-group" required="true" label="Cabin Category" description="Cabins listed in order of pricing and does not include potential group discounts (based on deposit date) or military discounts ($100/person w/military ID).  Single supplements are typically 50%." name="cabin-category">&#13;
			<option label="Suite, (255 sq ft), starting at $6230/person" value="suite-255-sq-ft-starting-at-6230person">Suite, (255 sq ft), starting at $6230/person</option>&#13;
			<option label="French Balcony, Category A+ (225 sq ft), starting at $5998/person" value="french-balcony-category-a-225-sq-ft-starting-at-5998person">French Balcony, Category A+ (225 sq ft), starting at $5998/person</option>&#13;
			<option label="French Balcony, Category A (170 sq ft), starting at $5198/person" value="french-balcony-category-a-170-sq-ft-starting-at-5198person">French Balcony, Category A (170 sq ft), starting at $5198/person</option>&#13;
			<option label="French Balcony, Category B (170 sq ft), starting at $5118/person" value="french-balcony-category-b-170-sq-ft-starting-at-5118person">French Balcony, Category B (170 sq ft), starting at $5118/person</option>&#13;
			<option label="French Balcony, Category C (170 sq ft), starting at $4878/person" value="french-balcony-category-c-170-sq-ft-starting-at-4878person">French Balcony, Category C (170 sq ft), starting at $4878/person</option>&#13;
			<option label="Fixed Windows, Category D (170 sq ft), starting at $3998/person" value="fixed-windows-category-d-170-sq-ft-starting-at-3998person">Fixed Windows, Category D (170 sq ft), starting at $3998/person</option>&#13;
			<option label="Fixed Windows, Category E (170 sq ft), starting at $3759/person" value="fixed-windows-category-e-170-sq-ft-starting-at-3759person">Fixed Windows, Category E (170 sq ft), starting at $3759/person</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are you interested in a Pre-Cruise or Post-Cruise Option?" description="AMA Pre- and Post-Cruise option include Hotel Stay  Breakfast  Tours &amp; Transportation to the ship" name="are-you-interested-in-a-precruise-option">&#13;
			<option label="Yes, PRE-Cruise (1 Night Paris &amp; 3 Nights in St Malo) " value="yes-precruise-1-night-paris-3-nights-in-st-malo-">Yes, PRE-Cruise (1 Night Paris &amp; 3 Nights in St Malo) </option>&#13;
			<option label="Yes, POST-Cruise (2 Nights Paris)" value="yes-postcruise-2-nights-paris">Yes, POST-Cruise (2 Nights Paris)</option>&#13;
			<option label="Yes, BOTH Pre &amp; Post Cruise options" value="yes-both-pre-post-cruise-options">Yes, BOTH Pre &amp; Post Cruise options</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Do any of these Options Apply to you? &amp;nbsp;Additional discounts may apply." name="do-any-of-these-options-apply-to-you-additional-discounts-may-apply">&#13;
			<option label="I currently hold an active or retired military ID" value="i-currently-hold-an-active-or-retired-military-id">I currently hold an active or retired military ID</option>&#13;
			<option label="I am currently a first responder or health care worker" value="i-am-currently-a-first-responder-or-health-care-worker">I am currently a first responder or health care worker</option>&#13;
			<option label="I have cruised with AMA before and have an AMA loyalty number" value="i-have-cruised-with-ama-before-and-have-an-ama-loyalty-number">I have cruised with AMA before and have an AMA loyalty number</option>&#13;
			<option label="I have a true AMEX platinum credit card (not an airline platinum AMEX)" value="">I have a true AMEX platinum credit card (not an airline platinum AMEX)</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Travel Insurance" description="NOTE:  AMA travel insurance must be paid at time of deposit and is not refundable  even if canceling before the pay in full date." name="travel-insurance">&#13;
			<option label="Include AMA Waterways travel protection to my quote (13%) PLUS the $80 Cancel for Any Reason future cruise credit option" value="include-ama-waterways-travel-protection-to-my-quote-13-plus-the-80-cancel-for-any-reason-future-cruise-credit-option">Include AMA Waterways travel protection to my quote (13%) PLUS the $80 Cancel for Any Reason future cruise credit option</option>&#13;
			<option label="Include AMA Waterways travel protection to my quote (13%)" value="include-ama-waterways-travel-protection-to-my-quote-13">Include AMA Waterways travel protection to my quote (13%)</option>&#13;
			<option label="I would prefer an Allianz travel insurance quote" value="i-would-prefer-an-allianz-travel-insurance-quote">I would prefer an Allianz travel insurance quote</option>&#13;
			<option label="I do not wish to add travel insurance at this time" value="i-do-not-wish-to-add-travel-insurance-at-this-time">I do not wish to add travel insurance at this time</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="AMA Ground Transportation Options" name="ama-ground-transportation-options">&#13;
			<option label="Include AMA ground transportation from the Airport to the Ship (Same Day)" value="include-ama-ground-transportation-from-the-airport-to-the-ship-same-day">Include AMA ground transportation from the Airport to the Ship (Same Day)</option>&#13;
			<option label="Include AMA ground transportation from the Ship to the Airport (Same Day)" value="include-ama-ground-transportation-from-the-ship-to-the-airport-same-day">Include AMA ground transportation from the Ship to the Airport (Same Day)</option>&#13;
			<option label="Include AMA Pre-Cruise ground transportation from the Airport to the Hotel (Hotel to Ship is complementary)" value="include-ama-precruise-ground-transportation-from-the-airport-to-the-hotel-hotel-to-ship-is-complementary">Include AMA Pre-Cruise ground transportation from the Airport to the Hotel (Hotel to Ship is complementary)</option>&#13;
		</field>&#13;
		<field type="textarea" label="Comments" name="comments" className="form-control"/>&#13;
	</fields>&#13;
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