Share your information with Jacqueline Gohlke

Jacqueline Gohlke

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    <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="Cruise Inquiry"/>&#13;
		<field type="header" subtype="h3" label="Full name&amp;nbsp;"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" placeholder="As shown on government-issued photo ID/passport" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" placeholder="As shown on government-issued photo ID/passport (if applicable)" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" placeholder="As shown on government-issued photo ID/passport" 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="date" required="true" label="Date of Birth (DOB)" name="date-of-birth" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Why do I ask for name and date of birth? Some cruise lines allow me to put a complimentary hold on a cruise with just a name and DOB, which locks in the price I am quoting for a set time!&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="How many travelers (including yourself)?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Names &amp;amp; DOBs of other travelers" name="names-dobs-of-other-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Do you have a specific cruise in mind?" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to depart?" 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="When would you like to return?" 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="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" label="What port would you like to depart from?" description="Please list any that would work for you" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What ports would you like to visit?" description="List any you are interested in-f you are not sure  that is fine too!" name="text-1727106039780" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Do you have a preferred cruise line? Do you have a preferred ship?" name="text-1727106058510" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Do all travelers have a valid passport?" placeholder="If the answer is no but you have applied  please provide your application date" name="do-all-travelers-have-a-passport" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is a comfortable budget PER PERSON?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="under $500" value="under-500">under $500</option>&#13;
			<option label="$500 to $1,500" value="500-to-1500">$500 to $1,500</option>&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000 to $11,000" value="10000-to-11000">$10,000 to $11,000</option>&#13;
			<option label="$11,000 to $12,000" value="11000-to-12000">$11,000 to $12,000</option>&#13;
			<option label="$12,000 to $15,000" value="12000-to-15000">$12,000 to $15,000</option>&#13;
			<option label="$15,000+" value="15000">$15,000+</option>&#13;
		</field>&#13;
		<field type="select" label="Do you want to include flights?" name="do-you-want-to-include-flights" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" label="Does your above budget include flights?" name="does-your-above-budget-include-flights" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Adventurous" value="adventurous">Adventurous</option>&#13;
			<option label="Adults-only" value="adultsonly">Adults-only</option>&#13;
		</field>&#13;
		<field type="text" label="Do you belong to any loyalty programs (for miles or points) or have any brand preferences?" placeholder="If so  please list which ones" name="do-you-belong-to-any-loyalty-programs-for-miles-or-points-or-have-any-brand-preferences" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are you a military member or a first responder?" name="are-you-a-military-member-or-a-first-responder">&#13;
			<option label="Active Duty Military" value="active-duty-military">Active Duty Military</option>&#13;
			<option label="Retired Military" value="retired-military">Retired Military</option>&#13;
			<option label="First Responder" value="first-responder">First Responder</option>&#13;
		</field>&#13;
		<field type="text" label="What is your state of residence?" name="what-is-your-state-of-residence" 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="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="Nightlife" value="nightlife">Nightlife</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="paragraph" subtype="p" label="**PLEASE NOTE: My services are free, but this means I am planning your trip for free and do not get paid until you travel. I ask that you please be respectful of my time and do not book on your own or with another travel agent using my quotes. Thank you!**"/>&#13;
		<field type="paragraph" subtype="p" label="**PLEASE NOTE: All pricing and availability quoted are subject to change until a hold has been placed and/or deposit has been paid**"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>