<?xml version="1.0" encoding="UTF-8"?>

<form url="mbi-res-en.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="465"
 height="423"
 bkcolor="0x010827"
 transparent="f"
 fontcolor="0x000000"
 outlinecolor="0x010827"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="false"
 verifymessage="The e-mail address you entered does not match!"
 reqmessage="One or more fields are required."
 invalidemailmsg="does not appear to be a valid e-mail address. Would you like to change it?"
 transition="3"
 autoresponseincluderesults="f"
 autoresponseaddtotop="f"
 usephp="true"
disableclicktoactiveprompt="false"
 extensions="*.txt;*.gif;*.jpg;*.jpeg;*.zip;*.doc;*.png;*.pdf;*.rtf;*.html;*.docx;*.xslx"
>

<hidden
 name="thankyoupage"
 value="http://miraclebeachinn.com/contact/Confirmation.html"
></hidden>

<hidden
 name="subject"
 value="RESERVATION"
></hidden>

<textinput
 name="Name"
 x="166"
 y="19"
 w="225"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="Address"
 x="166"
 y="44"
 w="226"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="CityProvState"
 x="165"
 y="69"
 w="225"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="ZipPostal"
 x="166"
 y="94"
 w="101"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="Country"
 x="166"
 y="119"
 w="101"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="Phone"
 x="166"
 y="144"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="Email"
 x="166"
 y="169"
 w="275"
 h="22"
 initvalue=""
 maxchars="50"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 emailbox="true"
 editable="true"
  restrict="email"
>
</textinput>

<combobox
 name="Room"
 x="141"
 y="219"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 isemail="false"
 w="100"
 h="20">
  <item name="Any free Room"></item>
  <item name="Bear&apos;s Den"></item>
  <item name="Cougar&apos;s Cove"></item>
  <item name="Eagle&apos;s Nest"></item>
</combobox>

<combobox
 name="Adults"
 x="141"
 y="244"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 required="true"
 isemail="false"
 w="56"
 h="20">
  <item name="#"></item>
  <item name="1"></item>
  <item name="2"></item>
  <item name="3"></item>
  <item name="4"></item>
</combobox>

<combobox
 name="Children"
 x="389"
 y="244"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 isemail="false"
 w="52"
 h="20">
  <item name="0"></item>
  <item name="1"></item>
  <item name="2"></item>
  <item name="3"></item>
  <item name="4"></item>
</combobox>

<combobox
 name="Arrival Month"
 x="165"
 y="294"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 required="true"
 isemail="false"
 w="109"
 h="20">
  <item name="Arrival Month"></item>
  <item name="January"></item>
  <item name="February"></item>
  <item name="March"></item>
  <item name="April"></item>
  <item name="May"></item>
  <item name="June"></item>
  <item name="July"></item>
  <item name="August"></item>
  <item name="September"></item>
  <item name="October"></item>
  <item name="November"></item>
  <item name="December"></item>
</combobox>

<combobox
 name="Arravil Day"
 x="291"
 y="294"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 required="true"
 isemail="false"
 w="57"
 h="20">
  <item name="Day"></item>
  <item name="1"></item>
  <item name="2"></item>
  <item name="3"></item>
  <item name="4"></item>
  <item name="5"></item>
  <item name="6"></item>
  <item name="7"></item>
  <item name="8"></item>
  <item name="9"></item>
  <item name="10"></item>
  <item name="11"></item>
  <item name="12"></item>
  <item name="13"></item>
  <item name="14"></item>
  <item name="15"></item>
  <item name="16"></item>
  <item name="17"></item>
  <item name="18"></item>
  <item name="19"></item>
  <item name="20"></item>
  <item name="21"></item>
  <item name="22"></item>
  <item name="23"></item>
  <item name="24"></item>
  <item name="25"></item>
  <item name="26"></item>
  <item name="27"></item>
  <item name="28"></item>
  <item name="29"></item>
  <item name="30"></item>
  <item name="31"></item>
</combobox>

<combobox
 name="ArrivalYear"
 x="364"
 y="294"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 required="true"
 isemail="false"
 w="77"
 h="20">
  <item name="2010"></item>
  <item name="2011"></item>
  <item name="2012"></item>
</combobox>

<combobox
 name="Departure Month"
 x="165"
 y="319"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 required="true"
 isemail="false"
 w="109"
 h="20">
  <item name="Departure Month"></item>
  <item name="January"></item>
  <item name="February"></item>
  <item name="March"></item>
  <item name="April"></item>
  <item name="May"></item>
  <item name="June"></item>
  <item name="July"></item>
  <item name="August"></item>
  <item name="September"></item>
  <item name="October"></item>
  <item name="November"></item>
  <item name="December"></item>
</combobox>

<combobox
 name="Departure Day"
 x="291"
 y="319"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 required="true"
 isemail="false"
 w="57"
 h="20">
  <item name="Day"></item>
  <item name="1"></item>
  <item name="2"></item>
  <item name="3"></item>
  <item name="4"></item>
  <item name="5"></item>
  <item name="6"></item>
  <item name="7"></item>
  <item name="8"></item>
  <item name="9"></item>
  <item name="10"></item>
  <item name="11"></item>
  <item name="12"></item>
  <item name="13"></item>
  <item name="14"></item>
  <item name="15"></item>
  <item name="16"></item>
  <item name="17"></item>
  <item name="18"></item>
  <item name="19"></item>
  <item name="20"></item>
  <item name="21"></item>
  <item name="22"></item>
  <item name="23"></item>
  <item name="24"></item>
  <item name="25"></item>
  <item name="26"></item>
  <item name="27"></item>
  <item name="28"></item>
  <item name="29"></item>
  <item name="30"></item>
  <item name="31"></item>
</combobox>

<combobox
 name="Departure Year"
 x="364"
 y="319"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 required="true"
 isemail="false"
 w="77"
 h="20">
  <item name="2010"></item>
  <item name="2011"></item>
  <item name="2012"></item>
</combobox>

<submitbutton
 name="Submit Button"
 x="176"
 y="365"
 w="100"
 h="38"
 label="Submit"
 fontname="Arial"
 fontcolor="0x000000"
  fontsize="12"
></submitbutton>

<label
 name="My Text 2"
 x="16"
 y="19"
 w="73"
 h="16"
 text="Full Name:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 3"
 x="16"
 y="44"
 w="58"
 h="16"
 text="Address:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 4"
 x="16"
 y="69"
 w="141"
 h="16"
 text="City / Province / State"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 5"
 x="16"
 y="94"
 w="115"
 h="16"
 text="Postal Code / Zip:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 6"
 x="16"
 y="119"
 w="57"
 h="16"
 text="Country:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 7"
 x="16"
 y="144"
 w="103"
 h="16"
 text="Phone Number:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 8"
 x="16"
 y="169"
 w="98"
 h="16"
 text="Email Address:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 10"
 x="41"
 y="294"
 w="83"
 h="16"
 text="Arrival Date:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 11"
 x="41"
 y="319"
 w="104"
 h="16"
 text="Departure Date:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 12"
 x="16"
 y="244"
 w="74"
 h="16"
 text="# of Adults:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 13"
 x="291"
 y="244"
 w="85"
 h="16"
 text="# of Children"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 14"
 x="16"
 y="219"
 w="109"
 h="16"
 text="Preferred Room:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFFFFFF"
  fontsize="13"
></label>

<label
 name="My Text 1"
 x="400"
 y="25"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 9"
 x="400"
 y="50"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 15"
 x="400"
 y="73"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 16"
 x="350"
 y="150"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 17"
 x="445"
 y="175"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 18"
 x="247"
 y="224"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 19"
 x="200"
 y="250"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 20"
 x="444"
 y="248"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 21"
 x="276"
 y="300"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 22"
 x="276"
 y="325"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 23"
 x="350"
 y="299"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 24"
 x="350"
 y="325"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 25"
 x="446"
 y="299"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 26"
 x="445"
 y="324"
 w="9"
 h="16"
 text="*"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

</form>