TravelJoy

Maria LaDuca

The Agency Chic - Pocono

Pocono Getaway

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Start Your Pocono Getaway Inquiry"/>&#13;
		<field type="text" required="true" label="First name" name="first-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" required="true" label="Cell number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Accommodation Type" name="vacation-type">&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="House Rental" value="house-rental">House Rental</option>&#13;
			<option label="Waterpark Resort" value="waterpark-resort">Waterpark Resort</option>&#13;
		</field>&#13;
		<field type="date" required="true" label="Trip Start Date" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="Trip End Date" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/>&#13;
		<field type="text" label="How will you be getting to the Poconos?" placeholder="Flying  driving?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="If traveling with kids please indicate the ages for kids on dates of travel" description="Example Mary will be 6 on June 11  2024 etc." name="if-traveling-with-kids-please-indicate-the-ages-for-kids-on-dates-of-travel" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are we celebrating a special occasion?" name="hotel-preference" other="true">&#13;
			<option label="Bachelor/Bachelorette Party" value="bachelorbachelorette-party">Bachelor/Bachelorette Party</option>&#13;
			<option label="Girls Trip" value="girls-trip">Girls Trip</option>&#13;
			<option label="Boys Trip" value="boys-trip">Boys Trip</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Engagement" value="engagement">Engagement</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Vineyard/Windery" value="vineyardwindery">Vineyard/Windery</option>&#13;
			<option label="Gambling/Casino" value="gamblingcasino">Gambling/Casino</option>&#13;
			<option label="Ski/Snow Tube" value="skisnow-tube">Ski/Snow Tube</option>&#13;
			<option label="Private Picnic" value="private-picnic">Private Picnic</option>&#13;
			<option label="Race Car Experience" value="race-car-experience">Race Car Experience</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Select Your Agent" name="select-your-agent" other="true">&#13;
			<option label="Adrienne" value="adrienne">Adrienne</option>&#13;
			<option label="Anthony" value="anthony">Anthony</option>&#13;
			<option label="Bianca" value="bianca">Bianca</option>&#13;
			<option label="GraceAnn" value="graceann">GraceAnn</option>&#13;
			<option label="Irma" value="">Irma</option>&#13;
			<option label="Jessmarie" value="jessmarie">Jessmarie</option>&#13;
			<option label="Joaquina" value="joaquina">Joaquina</option>&#13;
			<option label="Kait" value="kait">Kait</option>&#13;
			<option label="Kelli" value="kelli">Kelli</option>&#13;
			<option label="Maria" value="maria">Maria</option>&#13;
			<option label="Nicole" value="nicole">Nicole</option>&#13;
			<option label="New Client" value="new-client">New Client</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>