Share your information with Amy Bottorff

Amy Bottorff

Jackson Grantley Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Client Information"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#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 required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Interest&amp;nbsp;"/>&#13;
		<field type="checkbox-group" label="What type of trips most interest you!" name="what-type-of-trips-most-interest-you">&#13;
			<option label="Family Vacations" value="family-vacations">Family Vacations</option>&#13;
			<option label="Romantic Getaways" value="romantic-getaways">Romantic Getaways</option>&#13;
			<option label="Adventure Travel " value="adventure-travel-">Adventure Travel </option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="All Inclusive Resorts" value="all-inclusive-resorts">All Inclusive Resorts</option>&#13;
			<option label="Asia" value="asia">Asia</option>&#13;
			<option label="African Safari" value="african-safari">African Safari</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="How do you prefer to travel?" name="how-do-you-prefer-to-travel">&#13;
			<option label="With Kids" value="with-kids">With Kids</option>&#13;
			<option label="Adults Only" value="adults-only">Adults Only</option>&#13;
			<option label="Solo" value="solo">Solo</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="How Often do you Travel?" name="how-often-do-you-travel">&#13;
			<option label="Once a Year" value="once-a-year">Once a Year</option>&#13;
			<option label="A few Times a Year " value="a-few-times-a-year-">A few Times a Year </option>&#13;
			<option label="Whenever I can !!" value="whenever-i-can-">Whenever I can !!</option>&#13;
			<option label="Over 4 times a year " value="over-4-times-a-year-">Over 4 times a year </option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Just for Fun Are you more of A..." name="just-for-fun-are-you-more-of-a">&#13;
			<option label="Beach Lounger" value="beach-lounger">Beach Lounger</option>&#13;
			<option label="City Explorer" value="city-explorer">City Explorer</option>&#13;
			<option label="Adventure Seeker" value="adventure-seeker">Adventure Seeker</option>&#13;
			<option label="History Lover" value="history-lover">History Lover</option>&#13;
			<option label="Exploring quaint European towns" value="exploring-quaint-european-towns">Exploring quaint European towns</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What is your favorite travel splurge?" name="what-is-your-favorite-travel-splurge">&#13;
			<option label="Luxury Hotel " value="luxury-hotel-">Luxury Hotel </option>&#13;
			<option label="Once-in-a-lifetime-excursion" value="onceinalifetimeexcursion">Once-in-a-lifetime-excursion</option>&#13;
			<option label="Amazing Meals" value="amazing-meals">Amazing Meals</option>&#13;
			<option label="Shopping" value="shopping">Shopping</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Permissions" description="By submitting this client inquiry form  you consent to receive travel related content via email." name="permissions">&#13;
			<option label="yes, I understand and agree" value="yes-i-understand-and-agree">yes, I understand and agree</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>