Share your information with Daní Marie

Daní Marie

Daní Marie Travel

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Pre-departure information"/>&#13;
		<field type="header" subtype="h3" label="Passport details"/>&#13;
		<field type="text" label="Full name as it appears on your passport" description="It is important that this matches your passport exactly." name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Passport date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Passport expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="text" label="Passport issuing country" description="Which country issued your passport" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Gender" name="gender">&#13;
			<option label="F" value="f">F</option>&#13;
			<option label="M" value="m">M</option>&#13;
		</field>&#13;
		<field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Emergency Contact Information"/>&#13;
		<field type="text" label="Full name" name="emergency-contact-full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="emergency-contact-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Relationship to you" name="emergency-contact-relationship" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Additional Information"/>&#13;
		<field type="textarea" label="Do you have any dietary restrictions or food allergies? Favorite beverages?" name="dietary-restrictions" className="form-control"/>&#13;
		<field type="textarea" label="Do you have any medical conditions we need to be aware of?" name="medical-conditions" className="form-control"/>&#13;
		<field type="textarea" label="Anything else you think we should know? (Special requests, traveling with a group, comments, notes, etc.)" name="additional-notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>