Share your information with Sarah Roy

Sarah Roy

Lasting Impressions Travel, LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#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" 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" 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 required="true"  type="text" 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="checkbox-group" required="true" label="Guided Scotland Interest" name="guided-scotland-interest">&#13;
			<option label="May 2027" value="may-2027">May 2027</option>&#13;
			<option label="June 2027" value="june-2027">June 2027</option>&#13;
			<option label="September 2027" value="september-2027">September 2027</option>&#13;
			<option label="April 2028" value="april-2028">April 2028</option>&#13;
			<option label="September 2028" value="september-2028">September 2028</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many guests?" name="text-1775224310981" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Any children under the age of 18? If so, please list their age." name="text-1775224332428" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Do you and your traveling partner have valid passports?" name="do-you-and-your-traveling-partner-have-valid-passports" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Waiting on renewal" value="waiting-on-renewal">Waiting on renewal</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Do you have any mobility issues I should be aware of while planning?" name="select-1782058431365" className="form-control">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="I am not sure, I would like to speak with you in more detail. " value="i-am-not-sure-i-would-like-to-speak-with-you-in-more-detail-">I am not sure, I would like to speak with you in more detail. </option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Where would you be departing from?" name="text-1782058486060" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Is there anything else you want me to know?" name="textarea-1782058516324" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>