Share your information with Jelly Elias

Jelly Elias

IntelTravel

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#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" 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="date" label="When would you like to depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/>&#13;
		<field type="date" label="When would you like to return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/>&#13;
		<field type="textarea" label="List here preferred dates" name="list-here-preferred-dates" className="form-control"/>&#13;
		<field type="text" label="Where would you like to go?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Where would you like to sail out from (can list multiple ports)&amp;nbsp;" name="where-would-you-like-to-sail-out-from-can-list-multiple-ports-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget" className="radio-group">&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
			<option label="1,500 or less" value="1500-or-less">1,500 or less</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="radio-group" required="true" label="Cabin preference" name="seat-preference">&#13;
			<option label="Balcony Ocean" value="balcony-ocean">Balcony Ocean</option>&#13;
			<option label="Inside " value="inside-">Inside </option>&#13;
			<option label="Balcony inner ship" value="balcony-inner-ship">Balcony inner ship</option>&#13;
			<option label="no preference " value="no-preference-">no preference </option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" name="bed-preference">&#13;
			<option label="Two separate beds" value="two-separate-beds">Two separate beds</option>&#13;
			<option label="Beds put together " value="beds-put-together-">Beds put together </option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Cabin Location" name="cabin-location" multiple="multiple" className="form-control">&#13;
			<option label="Front of Ship" value="front-of-ship" selected="selected">Front of Ship</option>&#13;
			<option label="Middle of Ship" value="middle-of-ship">Middle of Ship</option>&#13;
			<option label="Back of Ship" value="back-of-ship">Back of Ship</option>&#13;
			<option label="No Preference " value="no-preference-">No Preference </option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Wifi Package&amp;nbsp;" name="wifi-package" multiple="multiple" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Drink Package" name="drink-package" multiple="multiple" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no" selected="selected">No</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Travel Insurance&amp;nbsp;" name="select-1780540834070" multiple="multiple" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="If you have a deck preference please list all here" name="if-you-have-a-deck-preference-please-list-all-here" className="form-control"/>&#13;
		<field type="textarea" label="Please list any other request here&amp;nbsp;" name="please-list-any-other-request-here-" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>