Share your information with Felicia Brandon

Felicia Brandon

Epiphany Travel Agency

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  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Thank you for considering to use Epiphany Travel Agency for your vacation wants and needs. ETA strives to provide excellent service, while helping you create a lifetime of memories."/>&#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" required="true" label="Last name" name="last-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="Birthdate" name="birthdate" className="form-control"/>&#13;
		<field type="text" label="Where would you like to go?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" 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" 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" required="true" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="If so, please describe how flexible." name="if-so-please-describe-how-flexible" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Flight Preference (Check all that apply)" name="flight-preference-check-all-that-apply">&#13;
			<option label="Non-stop - price does not matter" value="nonstop-price-does-not-matter">Non-stop - price does not matter</option>&#13;
			<option label="Non-stop - depends on price" value="nonstop-depends-on-price">Non-stop - depends on price</option>&#13;
			<option label="Maximum 1 layover" value="maximum-1-layover">Maximum 1 layover</option>&#13;
			<option label="Maximum 2 layovers" value="maximum-2-layovers">Maximum 2 layovers</option>&#13;
			<option label="Cheapest option" value="cheapest-option">Cheapest option</option>&#13;
			<option label="No preference" value="no-preference">No preference</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Number of adults traveling" name="number-of-adults-traveling" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Full names and birth dates of adults" name="full-names-and-birth-dates-of-adults" className="form-control"/>&#13;
		<field type="text" label="Number of children traveling" name="number-of-children-traveling" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Full names and birth dates of children" name="full-names-and-birth-dates-of-children" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your budget per person?" description="This just gives me a general starting point and can always be changed later." name="budget" other="true">&#13;
			<option label="$2,500 to $4,500" value="2500-to-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+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vacation are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="All Inclusive Resort" value="all-inclusive-resort">All Inclusive Resort</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Resort/Hotel &amp; Air" value="resorthotel-air">Resort/Hotel &amp; Air</option>&#13;
			<option label="Resort/Hotel Only" value="resorthotel-only">Resort/Hotel Only</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="If you are looking to cruise, which Cruise Line would you like to book with?" name="if-you-are-looking-to-cruise-which-cruise-line-would-you-like-to-book-with" other="true">&#13;
			<option label="Carnival Cruise Lines" value="carnival-cruise-lines">Carnival Cruise Lines</option>&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option>&#13;
			<option label="MSC Cruise Lines" value="msc-cruise-lines">MSC Cruise Lines</option>&#13;
			<option label="Norwegian Cruise Lines" value="norwegian-cruise-lines">Norwegian Cruise Lines</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="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Are you interested in adult only resorts?" name="are-you-interested-in-adult-only-resorts">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No " value="no-">No </option>&#13;
			<option label="Doesn't matter" value="doesnt-matter">Doesn't matter</option>&#13;
			<option label="Does not apply" value="does-not-apply">Does not apply</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="radio-group" required="true" label="A deposit is required to book your vacation. How soon would you be able to make a deposit after finding your dream vacation?" name="a-deposit-is-required-to-book-your-vacation-how-soon-would-you-be-able-to-make-a-deposit-after-finding-your-dream-vacation" other="true">&#13;
			<option label="Immediately" value="immediately">Immediately</option>&#13;
			<option label="A few days" value="a-few-days">A few days</option>&#13;
			<option label="A week or two" value="a-week-or-two">A week or two</option>&#13;
			<option label="More than two weeks" value="more-than-two-weeks">More than two weeks</option>&#13;
			<option label="Not sure" value="not-sure">Not sure</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Have you performed any online searches?" name="have-you-performed-any-online-searches">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Have you consulted another travel professional?" name="have-you-consulted-another-travel-professional">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How did you hear about Epiphany Travel Agency (ETA)?" name="how-did-you-hear-about-epiphany-travel-agency-eta" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="&amp;nbsp;Check out ETA&#39;s upcoming group experiences by visiting www.epiphanytravelagency.com."/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>