TravelJoy

Saraya Motley

LuxPrima Travel

Guild Dolce Vita Pilot

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="CLIENT INFORMATION&amp;nbsp;"/>&#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="Preferred name" name="preferred-name" 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="checkbox-group" label="Preferred method of contact (email/phone/text)" name="preferred-method-of-contact-emailphonetext">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Confirm 65+" name="confirm-65">&#13;
			<option label="I confirm I AM 65+" value="i-confirm-i-am-65">I confirm I AM 65+</option>&#13;
			<option label="I am NOT 65+" value="i-am-not-65">I am NOT 65+</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="ABOUT YOUR TRIP&amp;nbsp;"/>&#13;
		<field type="text" label="Where are you currently based" name="where-would-you-like-to-go-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Why are you interested in the Guild Siena “Italian Dolce Vita” pilot?&amp;nbsp;" name="what-is-your-departure-city-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Will you be traveling solo or with a companion? (Solo/With companion—please provide name/relationship if known)" name="is-this-vacation-to-celebrate-anything-special-" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Are you available for a 14 day stay starting April 20th?&amp;nbsp;" name="are-your-dates-flexible-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="I am not sure (if you check this box please explain below)" value="i-am-not-sure-if-you-check-this-box-please-explain-below">I am not sure (if you check this box please explain below)</option>&#13;
		</field>&#13;
		<field type="textarea" label="Anything else you’d like us to know at this stage?&amp;nbsp;" name="who-will-be-traveling-please-list-all-full-names-including-middle-and-birthdays-" className="form-control"/>&#13;
		<field type="select" label="Would you like to be subscribed to our company newsletter?&amp;nbsp;" name="would-you-like-to-be-subscribed-to-our-company-newsletter-" className="form-control">&#13;
			<option label="Yes- sign me up!" value="yes-sign-me-up">Yes- sign me up!</option>&#13;
			<option label="No, I get too many emails" value="no-i-get-too-many-emails">No, I get too many emails</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>