TravelJoy

Maria LaDuca

The Agency Chic - Pocono

Surprise Trips

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  <body>
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		<field type="header" subtype="h1" label="Let's Get The Basics"/>&#13;
		<field type="date" required="true" label="When Do you want to start your trip?" description="This is the day you leave your home to begin your trip." name="when-do-you-want-to-start-your-trip" className="form-control"/>&#13;
		<field type="date" required="true" label="What date do you want to be home?" description="This is the day you must be home." name="what-date-do-you-want-to-be-home" className="form-control"/>&#13;
		<field type="text" required="true" label="How many people are traveling with you? &amp;nbsp;If adults/kids please indicate age of kids at the time of travel for most accurate pricing." name="how-many-people-are-traveling-with-you-if-adultskids-please-indicate-age-of-kids-at-the-time-of-travel-for-most-accurate-pricing" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Vacation Type" description="What type of experience are you looking for?" name="vacation-type" other="true">&#13;
			<option label="Involving a flight" value="involving-a-flight">Involving a flight</option>&#13;
			<option label="Within a 5 hour drive" value="within-a-5-hour-drive">Within a 5 hour drive</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Requires a passport" value="requires-a-passport">Requires a passport</option>&#13;
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		<field type="checkbox-group" required="true" label="Total Package Price Range" description="The world is vast! To help us decide where you go let us know how much you want to spend." name="total-package-price-range" other="true">&#13;
			<option label="1500-3000" value="15003000">1500-3000</option>&#13;
			<option label="3000-4500" value="30004500">3000-4500</option>&#13;
			<option label="4500-6000" value="45006000">4500-6000</option>&#13;
			<option label="6000-7500" value="60007500">6000-7500</option>&#13;
			<option label="7500-10,000" value="750010000">7500-10,000</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Where do you NOT want to go?" placeholder="Use this space to indicate places you do NOT want to visit." name="where-do-you-not-want-to-go" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What Activities are you interested in?" description="Select all that apply" name="what-activities-are-you-interested-in" other="true">&#13;
			<option label="Restaurants" value="restaurants">Restaurants</option>&#13;
			<option label="Bars/Pubs" value="barspubs">Bars/Pubs</option>&#13;
			<option label="Food Tours" value="food-tours">Food Tours</option>&#13;
			<option label="History" value="history">History</option>&#13;
			<option label="Music" value="music">Music</option>&#13;
			<option label="Culture" value="culture">Culture</option>&#13;
			<option label="Arts" value="arts">Arts</option>&#13;
			<option label="Build/Make Something" value="buildmake-something">Build/Make Something</option>&#13;
			<option label="Rest/Relaxation" value="restrelaxation">Rest/Relaxation</option>&#13;
			<option label="Active/Exerscise " value="activeexerscise-">Active/Exerscise </option>&#13;
			<option label="Photo Shoot" value="photo-shoot">Photo Shoot</option>&#13;
			<option label="Involving Heights" value="involving-heights">Involving Heights</option>&#13;
			<option label="Amusement Parks" value="amusement-parks">Amusement Parks</option>&#13;
			<option label="Spa/Massages" value="spamassages">Spa/Massages</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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="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="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
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