TravelJoy

Christy Bergen

Bergen Travels Powered by Travelmation

Vacation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name (as seen on your passport)" 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 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="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="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Details"/>&#13;
		<field type="select" label="What type of vacation are you looking for?" name="what-type-of-vacation-are-you-looking-for" className="form-control">&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="All Inclusive" value="all-inclusive">All Inclusive</option>&#13;
			<option label="Weddings" value="weddings">Weddings</option>&#13;
			<option label="Disney Resorts" value="disney-resorts">Disney Resorts</option>&#13;
			<option label="Disney Cruise" value="disney-cruise">Disney Cruise</option>&#13;
			<option label="Adventure Tours" value="adventure-tours">Adventure Tours</option>&#13;
		</field>&#13;
		<field type="text" label="Where Would You Like to Go?&amp;nbsp;" name="where-would-you-like-to-go-" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Would you like your vacation to include any of the following?" name="would-you-like-your-vacation-to-include-any-of-the-following" multiple="multiple" className="form-control">&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Excursions" value="excursions">Excursions</option>&#13;
			<option label="Car Rentals" value="car-rentals">Car Rentals</option>&#13;
			<option label="Transfers between airport and destination" value="transfers-between-airport-and-destination">Transfers between airport and destination</option>&#13;
			<option label="No Add-Ons: Stay only" value="no-addons-stay-only">No Add-Ons: Stay only</option>&#13;
		</field>&#13;
		<field type="date" required="true" label="Preferred Departure Date" name="preferred-departure-date" className="form-control"/>&#13;
		<field type="date" label="Preferred Return Date" name="preferred-return-date" className="form-control"/>&#13;
		<field type="radio-group" label="Are your dates Flexible?&amp;nbsp;" inline="true" name="are-your-dates-flexible-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Airports you would like to depart from?&amp;nbsp;" name="airports-you-would-like-to-depart-from-" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Would You Like TRAVEL INSURANCE included in your quote" name="would-you-like-travel-insurance-included-in-your-quote" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No-I will fill out a waiver denying travel insurance" value="noi-will-fill-out-a-waiver-denying-travel-insurance">No-I will fill out a waiver denying travel insurance</option>&#13;
		</field>&#13;
		<field type="select" label="Will your US PASSPORT be active for this trip?" name="will-your-us-passport-be-active-for-this-trip" className="form-control">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Passport Info- If You Have It"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="radio-group" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
			<option label="X" value="other">X</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="h2" label="Travel Preferences"/>&#13;
		<field type="radio-group" label="Seat preference" name="seat-preference">&#13;
			<option label="Window" value="window">Window</option>&#13;
			<option label="Aisle" value="aisle">Aisle</option>&#13;
			<option label="Opposite aisle" value="opposite aisle">Opposite aisle</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
		</field>&#13;
		<field type="text" label="Meal preference" name="meal-preference" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Hotel preference" name="hotel-preference">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Vibe preferences" name="vibe-preference">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
			<option label="Multi-generational" value="multi-generational">Multi-generational</option>&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
			<option label="LGBT" value="lgbt">LGBT</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Activity preferences" name="activity-preferences">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theatre" value="art-theatre">Arts and theatre</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>