<html> <body> <form-template> <fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field> <field type="header" subtype="h2" label="Full name"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Important Dates"/> <field type="date" label="Birthday" name="birthday" className="form-control"/> <field type="header" subtype="h2" label="Questions for your trip"/> <field type="text" label="Where would you like to go?" description="If you're not sure just give me a few destinations you're considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/> <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"/> <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"/> <field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> </field> <field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="textarea" label="Please enter the names, email address, and date of birth for additional travelers." name="textarea-1687451194020" className="form-control"/> <field type="radio-group" label="What is your budget for all travelers? (Excluding flights)" description="This just gives us a general starting point and can always be changed later." name="budget" other="true"> <option label="$10,000 to $15000" value="10000-to-15000">$10,000 to $15000</option> <option label="$15000 to $20000" value="15000-to-20000">$15000 to $20000</option> <option label="$20000 to $25000" value="20000-to-25000">$20000 to $25000</option> <option label="$25000 to $30000" value="25000-to-30000">$25000 to $30000</option> <option label="$30000 +" value="30000-">$30000 +</option> </field> <field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true"> <option label="Economy" value="value">Economy</option> <option label="Moderate" value="moderate">Moderate</option> <option label="Luxury" value="luxury">Luxury</option> <option label="Boutique" value="boutique">Boutique</option> </field> <field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option> <option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option> <option label="Party" value="party">Party</option> <option label="Local culture" value="local-culture">Local culture</option> <option label="Family friendly" value="family-friendly">Family friendly</option> <option label="Food and wine" value="food-wine">Food and wine</option> </field> <field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true"> <option label="Beach and water" value="beach-water">Beach and water</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Scuba" value="scuba">Scuba</option> <option label="Adventure activities" value="adventure">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theater" value="art-theater">Arts and theater</option> <option label="Historical" value="historical">Historical</option> <option label="Hiking/Biking" value="hikingbiking">Hiking/Biking</option> <option label="Nature" value="nature">Nature</option> </field> <field type="checkbox-group" required="true" label="Pace of Travel" name="pace-of-travel" other="true"> <option label="Relaxed - no more than one planned activity or excursion per day and some days free to explore." value="relaxed-no-more-than-one-planned-activity-or-excursion-per-day-and-some-days-free-to-explore">Relaxed - no more than one planned activity or excursion per day and some days free to explore.</option> <option label="Independent - I want a few options of activities but mostly want to self explore." value="independent-i-want-a-few-options-of-activities-but-mostly-want-to-self-explore">Independent - I want a few options of activities but mostly want to self explore.</option> <option label="Immersive - I would enjoy planned out days filled with experiences that cater to my interests." value="immersive-i-would-enjoy-planned-out-days-filled-with-experiences-that-cater-to-my-interests">Immersive - I would enjoy planned out days filled with experiences that cater to my interests.</option> </field> <field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/> <field type="textarea" label="Do any travelers have any dietary restrictions?" name="textarea-1687451111233" className="form-control"/> <field type="textarea" label="Do any travelers have any mobility restrictions? " name="textarea-1687451155558" className="form-control"/> <field type="textarea" label="What else would you like me to know that would help our itinerary design?" description="What else would you like me to know about your travelers budget and/or travel preferences?" name="notes" className="form-control"/> <field type="checkbox-group" required="true" label="Terms and Conditions" description="We are VLX Travel and are excited to help you with your travel. The following terms & conditions (the "Agreement") describe what you can expect from us. The terms "we" "us" and "our" refer to VLX Travel and the term "you" refers to the individual who signs this agreement. CUSTOMER RESPONSIBILITIES Travel documents including passports visas, and health/vaccination certificates required are your responsibility. Valid passports are absolutely required for all international destinations and the expiration date should be at least 6 months following the return date of your trip. Some countries require that your passport have two to four blank visa/stamp pages. Some airlines will not allow you to board if this requirement is not met. When traveling domestically or internationally, the U.S. Transportation Security Administration (TSA) and U.S. Department of Homeland Security (DHS) advise that everyone carry at least two forms of acceptable identification in order to board a flight. (See this link.) Examples: DHS designated enhanced driver’s license, USA Passport, a foreign government passport. The name, date of birth and gender that appears on the identification card must exactly match the same such data that is listed on airline ticket(s) and booking records. Additionally, a visa and vaccinations may be required. Please note that even when a visa is issued, a traveler may be denied entry since each country’s local immigration officials make the final entry decision. Several factors including past criminal record may contribute to the decision of the local immigration official(s). Should a visa not be issued, VLX Travel is not responsible for lost payments made toward the contemplated trip. If traveling to or through Canada, travelers with a Driving While Intoxicated (DWI) or other conviction record should always check whether current rules exclude admission. VLX Travel feels it is an invasion of privacy to make such an inquiry of you. The final decision of entry rests with the immigration or border services officer. For more information see Canada's government site and the Canadian Immigration facts. Visit the USA State Department Web site www.travel.state.gov on a regular basis for information regarding incidence of disease, terrorism, safety issues, crime, the need for travel documentation (such as passports, visas, proof of health/vaccination certificates) health hazards, and other restrictions regarding travel to your domestic and/or international destination(s), and re-entry into the United States. Required or advised inoculations you decide to obtain upon the advice of your personal physician may need to be administered in a series of doses months ahead of your planned departure and such time element should be taken into account by you when making deposits and/or nonrefundable final payments. Visit the websites of the USA Centers for Disease Control and the International Society of Travel Medicine. TERMS AND CONDITIONS Availability and price quotes are applicable to the date and time at which they are requested and cannot be guaranteed until payment is made. Quotes in a foreign currency fluctuate with exchange rates and international payments may carry a foreign transaction fee. VLX Travel will make every effort to honor the price as originally quoted, however, under certain circumstances additional costs by a supplier or government may be imposed due to an increase in the cost for one or more of the travel components. Flight confirmation is subject to availability and prices are subject to change after the date of deposit, including price increases in the fee for a seat assignment, fee for baggage, applicable fuel surcharges, or an increase in a government-imposed fee or tax. Passport copies are required to confirm international air reservations. Correct legal names that match identification to be used for travel must be provided by the client to VLX Travel. Name changes are not permitted on airline tickets. Clients are responsible for providing accurate information on the Traveler Info Form. VLX Travel is not responsible for costs incurred by incorrect information provided for travel planning including reservations and airline tickets. Once purchased, US air transaction prices will not increase, except for potential charges resulting from government-imposed taxes or fees. You consent to pay for such charges and authorize VLX Travel to charge my credit card for such additional amounts. Certain suppliers reserve the right to increase prices to cover increased costs, fuel surcharges, tariffs and taxes, and to reflect fluctuations in foreign exchange markets. If for any reason your credit card charges are later declined, reversed, or VLX Travel is unable to receive payment for the travel plans and services, you acknowledge that this is a binding contract between you and VLX Travel, and VLX Travel shall be entitled to recovery, including reasonable attorneys’ fees in connection with collection. VLX Travel offers retail travel services to customers, which are provided by separate and independent vendors of travel services. VLX Travel does not operate, control, or otherwise provide the services of the independent travel vendors. Hence, you agree that VLX Travel acts only as agent for the client in acquiring transportation, hotel accommodations, sightseeing and other privileges, or services for your benefit, and on the express condition that VLX Travel shall not be responsible for any loss, accident, injury, delay, defect, omission or irregularity which may occur or be occasioned, whether by reason of any act, negligence or default of any company or person engaged in or responsible for carrying out any of the arrangements, or otherwise in connection therewith. It is the responsibility of the client to verify all information is correct. VLX Travel will not be responsible for omissions or errors if not brought to our attention immediately. VLX Travel strongly recommends travel insurance be purchased for all travelers at the time of initial deposit to cover risks inherent in travel. VLX Travel advisors are not insurance experts and cannot guarantee the adequacy or extent of an insurance policy. Travelers are advised to read and become acquainted with policy documents and contact the insurer for clarification or concerns. VLX Travel shall not assume responsibility for any air and/or ground schedule changes. it is the client’s responsibility to make appropriate air arrangements in the case of cancellations or delays. Cancellations: Cancellations are subject to provider cancellation policies and the client is responsible for all applicable cancellation costs, charges or fees charged by Providers. VLX Travel is not responsible to pay for any loss the client incurs due to failure to travel or failure to follow the change or cancel policies of any travel vendor. VLX travel charges a $100 fee for cancellation assistance. VLX travel fees and air ticketing fees are non-refundable. Cancellations are subject to provider cancellation policies and the client is responsible for all applicable cancellation costs, charges or fees charged by Providers. Changes: Any changes to a reservation that has been confirmed are subject to the terms and conditions of the supplier. There are fees associated with changes to confirmed reservations: $50 for hotel, ground transportation, or tours and a $100 fee for air, per ticket. VLX Travel provides travel planning services for the fees - please review the information on our website. COVID-19As the worldwide COVID-19 corona-virus and other health threats are unpredictable and can impact travel, I acknowledge that for this reason, and other reasons not reasonably foreseeable at this time, these travel plans may be interrupted or canceled by the supplier that is providing them, a government entity or other third party over which VLX Travel has no control. I further acknowledge that the supplier's own cancellation, re-booking and refund policies, subject to any applicable law that is now or may later be in effect, will govern my rights and remedies, including my right to receive a refund, in such an event. Moreover, I understand that should I elect to purchase travel insurance, the terms of the policy will dictate whether, and to what extent, coverage for any financial loss may exist under the circumstances. By signing below, I hereby agree to hold VLX Travel harmless and release the agency from all liability for any damages, including but not limited to monetary losses, I may incur as a result of such interruption or cancellation of these travel plans. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 while traveling. Such exposure or infection may result in personal injury, illness, permanent disability, and possible death. I voluntarily agree to assume all the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with VLX Travel. INTERNATIONAL TRAVEL RELEASE While VLX and our affiliate Departure Lounge travel advisors encourage wanderlust and an adventurous spirit, we do not endorse all destinations for all travelers. Please carefully research the pros, cons, and risks of visiting any destination before finalizing your travel plans. Ultimately, Departure Lounge and our VLX Travel travel advisors are not responsible for your safety here or abroad. We focus our efforts on recommending best-in-class travel providers to you, but it is impossible to guarantee your safety. Please review U.S. State Department advisories and third-party news and recommendations as you decide which destinations you will visit on your travels. By signing this release statement, you acknowledge that you have thoroughly researched the possible risks of your chosen destination and you still want your travel advisor to make your travel arrangements to visit this country/countries. Furthermore, you will not hold Departure Lounge or VLX Travel liable or responsible for your well-being during your visit to the destination. " name="terms-and-conditions"> <option label="I agree to VLX Travel's Terms and Conditions | https://www.vlxtravel.com/terms-conditions " value="i-agree-to-vlx-travels-terms-and-conditions-httpswwwvlxtravelcomtermsconditions-">I agree to VLX Travel's Terms and Conditions | https://www.vlxtravel.com/terms-conditions </option> </field> </fields> </form-template> </body> </html>
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