Share your information with Erica Weinelt Tidman

Erica Weinelt Tidman

Mixed Luggage Travel Company

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Divas with the Details Travel Inquiry Form"/>&#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="Significant Other&#39;s name" name="fiances-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="date" required="true" label="When will you be getting / did you get married?" name="starting-at" className="form-control"/>&#13;
		<field type="date" label="When would you like to depart for your trip?" description="This just gives me a general idea of when you would like to go; it can be changed later." name="date-1754326502505" className="form-control"/>&#13;
		<field type="date" label="When would you like to return from your trip?" description="This just gives me a general idea of when you would like to return; it can be changed later." name="ending-at" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget for this trip?" description="This gives me a general starting point and can be changed later." name="budget" other="true">&#13;
			<option label="$5,000 to $7,500" value="5000-to-7500">$5,000 to $7,500</option>&#13;
			<option label="$7,500 to $10,000" value="7500-to-10000">$7,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is your preferred departure city?" description="Where will you be flying from?" placeholder="ex: PHL" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Do you have a specific destination in mind?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Aruba" name="text-1754326604643" subtype="text" className="form-control"/>&#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="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Adventure activities (zip lining, ATV, etc.)" value="adventure-activities-zip-lining-atv-etc">Adventure activities (zip lining, ATV, etc.)</option>&#13;
			<option label="Hiking" value="hiking">Hiking</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="arts-and-theater">Arts and theater</option>&#13;
			<option label="History and culture" value="history-and-culture">History and culture</option>&#13;
			<option label="Food and wine" value="food-and-wine">Food and wine</option>&#13;
			<option label="Spa and relaxation" value="spa-and-relaxation">Spa and relaxation</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="Where have you traveled in the past?" description="Name some of your favorite hotels or destinations" name="where-have-you-traveled-in-the-past" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What would you like me to know about your trip and travel preferences?" name="what-else-would-you-like-me-to-know" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What is the best time for me to give you a call to introduce myself and review this information?" name="what-is-the-best-time-for-me-to-give-you-a-call-to-introduce-myself-and-review-this-information" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>