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<form-template><fields><field type="htmlElement" element_type="h1" element_content="Select Casino(s)"/><field type="htmlElement" element_type="paragraph" elementclass="logo1"/><field type="htmlElement" element_type="paragraph" elementclass="logo3"/><field type="htmlElement" element_type="paragraph" elementclass="logo4"/><field type="htmlElement" element_type="paragraph" elementclass="logo5"/><field required="true" type="checkbox-group" name="select-casino"><option value="Orion Stars">game1</option><option value="Juwa">game3</option><option value="Game Vault">game4</option><option value="Ultra Panda">game5</option></field><field required="true" type="checkbox" name="age" label="I am at Least 18 Years Old"/><field required="true" type="text" name="first-name-casino" label="First"/><field required="true" type="text" name="last-name-casino" label="Last"/><field required="true" type="text" name="email-address-casino" label="Email Address"/><field required="true" type="text" name="phone-number-casino" label="Phone"/><field required="true" type="date" name="date-casino" label="Date of birth"/><field required="true" type="text" name="state-casino" label="State"/><field required="true" type="text" name="city-casino" label="City"/><field required="true" type="text" name="zip-casino" label="Zip Code"/><field type="hidden" name="rendered-form" value="is_rendered"/></fields></form-template>

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