Share your information with Your Travel Concierges

Your Travel Concierges

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Christmastime on the Legendary Danube with 2 nights in Prague"/>&#13;
		<field type="checkbox-group" label="Stateroom Type" name="stateroom-type">&#13;
			<option label="Royal Suite" value="royal-suite">Royal Suite</option>&#13;
			<option label="Panorama Suite Category P" value="panorama-suite-category-p">Panorama Suite Category P</option>&#13;
			<option label="Panorama Suite Category A" value="panorama-suite-category-a">Panorama Suite Category A</option>&#13;
			<option label="Panorama Suite Category B" value="panorama-suite-category-b">Panorama Suite Category B</option>&#13;
			<option label="Deluxe Stateroom Category (D or E)" value="deluxe-stateroom-category-d-or-e">Deluxe Stateroom Category (D or E)</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Passenger 1"/>&#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 required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Birthday" name="birthday" 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 type="header" subtype="h2" label="Passenger 2"/>&#13;
		<field type="text" label="Full Name (as it appears on your passport)" name="full-name-as-it-appears-on-your-passport" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Birthday - Passenger 2" name="birthday-passenger-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Email - Passenger 2" name="email-passenger-2" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Comments/Requests" placeholder="Do you need a roommate  have special requests, need a scooter?" name="commentsrequests" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>