Share your information with Michelle Belcher

Michelle Belcher

Archer Escapes LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#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" label="Middle name" name="middle-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="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Lead Traveler&#39;s Birthday" name="lead-travelers-birthday" className="form-control"/>&#13;
		<field type="text" label="Additional Traveler Name(s)" name="additional-traveler-names" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Additional Traveler Birthday(s)" name="additional-traveler-birthdays" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" description="List all cities if you are considering a multi-leg itinerary." placeholder="ex: Tahiti" 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;
			<option label="No" value="no">No</option>&#13;
		</field>&#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="select" required="true" label="Will you need airfare in your package?" name="will-you-need-airfare-in-your-package" className="form-control">&#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="Estimated budget per traveler" name="estimated-budget-per-traveler" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Are you celebrating something (honeymoon, anniversary)? Is this a leisure trip?" name="are-you-celebrating-something-honeymoon-anniversary-is-this-a-leisure-trip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Accommodation style: Boutique Hotel, Modern Hotel, Bed &amp;amp; Breakfast or other?&amp;nbsp;" name="accommodation-style-boutique-hotel-modern-hotel-bed-breakfast-or-other-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Travel between cities: Rail, rental car, on your own? (if applicable)" name="travel-between-cities-rail-rental-car-on-your-own-if-applicable" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Any other inclusions and comments (sightseeing interests, accommodation requests, airport transfer services, etc.):" name="any-other-inclusions-and-comments-sightseeing-interests-accommodation-requests-airport-transfer-services-etc" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How did you hear about my services?" name="how-did-you-hear-about-my-services">&#13;
			<option label="The Knot/Wedding Wire" value="the-knotwedding-wire">The Knot/Wedding Wire</option>&#13;
			<option label="Social Media (IG/facebook)" value="social-media-igfacebook">Social Media (IG/facebook)</option>&#13;
			<option label="Referral/Word of Mouth" value="referralword-of-mouth">Referral/Word of Mouth</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
			<option label="Returning client" value="returning-client" selected="selected">Returning client</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>