Share your information with Laura Chappel

Laura Chappel

Travelmation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Contact Information"/>&#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="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="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Full Names and birthdates of all travelers" name="full-names-and-birthdates-of-all-travelers" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" 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" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" 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="radio-group" label="What cruise line would you like to travel with or know more about?&amp;nbsp;" name="what-cruise-line-would-you-like-to-travel-with-or-know-more-about-">&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Royal Caribbean Cruise Line" value="royal-caribbean-cruise-line">Royal Caribbean Cruise Line</option>&#13;
			<option label="Celebrity Cruise Line" value="celebrity-cruise-line">Celebrity Cruise Line</option>&#13;
			<option label="Carnival Cruise Line" value="carnival-cruise-line">Carnival Cruise Line</option>&#13;
			<option label="Norwegian Cruise Line" value="norwegian-cruise-line">Norwegian Cruise Line</option>&#13;
			<option label="Princess Cruise Line" value="princess-cruise-line">Princess Cruise Line</option>&#13;
			<option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Preferred Travel Dates" name="preferred-travel-dates" className="form-control"/>&#13;
		<field type="radio-group" label="Room Category Preference&amp;nbsp;" name="room-category-preference-">&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Ocean View" value="ocean-view">Ocean View</option>&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Dining Time" name="dining-time">&#13;
			<option label="Early" value="early">Early</option>&#13;
			<option label="Late" value="late">Late</option>&#13;
			<option label="My Time" value="my-time">My Time</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Travel Insurance" name="travel-insurance">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Do you want to prepay gratuities?&amp;nbsp;" name="do-you-want-to-prepay-gratuities-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>