<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Contact Info"/> <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" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="radio-group" label="Have you worked with a travel advisor before?&nbsp;" name="radio-group-1663164279982"> <option label="Yes!" value="yes">Yes!</option> <option label="I'm a first-timer!" value="im-a-firsttimer">I'm a first-timer!</option> </field> <field type="checkbox-group" required="true" label="What trip are you interested in?" description="Check all that apply." name="checkbox-group-1663164282807" other="true"> <option label="Whale Watching in the North West" value="whale-watching-in-the-north-west">Whale Watching in the North West</option> <option label="Three Continent Cruise " value="three-continent-cruise-">Three Continent Cruise </option> <option label="Wine River Cruise " value="wine-river-cruise-">Wine River Cruise </option> <option label="South Africa Safari " value="south-africa-safari-">South Africa Safari </option> <option label="US National Park Hiking Trip" value="us-national-park-hiking-trip">US National Park Hiking Trip</option> <option label="Ladies Only" value="ladies-only">Ladies Only</option> </field> <field type="textarea" label="What is it about this destination that interests you?&nbsp;" name="textarea-1663164307277" className="form-control"/> <field type="text" label="Are there any medical or dietary needs/preferences ? Does anyone in your party have mobility issues I should be aware of?" name="meal-preference" subtype="text" className="form-control"/> <field type="text" label="If you need flights included, what is your departure city?&nbsp;" description="Where will you be flying from?" name="text-1663164316474" subtype="text" className="form-control"/> <field type="text" label="Preferred airline(s) and class of service, if any?&nbsp;" name="text-1663164316746" subtype="text" className="form-control"/> <field type="radio-group" label="Do you plan on using any points or miles for any part of your booking?" inline="true" name="do-you-plan-on-using-any-points-or-miles-for-any-part-of-your-booking"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" label="Which of these are the top 3 priorities?&nbsp;" description="Check all that apply" name="checkbox-group-1663164320316" other="true"> <option label="Best accommodations" value="best-accommodations">Best accommodations</option> <option label="Private tours" value="private-tours">Private tours</option> <option label="Authentic, immersive experiences" value="authentic-immersive-experiences">Authentic, immersive experiences</option> <option label="Best experience for the money " value="best-experience-for-the-money-">Best experience for the money </option> <option label="Just the highlights/main attractions" value="just-the-highlightsmain-attractions">Just the highlights/main attractions</option> <option label="Small, cozy hotel (more boutique)" value="small-cozy-hotel-more-boutique">Small, cozy hotel (more boutique)</option> <option label="Large property with on-site dining & amenities" value="large-property-with-onsite-dining-amenities">Large property with on-site dining & amenities</option> <option label="Guided tours " value="guided-tours-">Guided tours </option> <option label="Basic accommodations: clean, safe, well-located" value="basic-accommodations-clean-safe-welllocated">Basic accommodations: clean, safe, well-located</option> <option label="Just the tickets/ no guide" value="just-the-tickets-no-guide">Just the tickets/ no guide</option> <option label="Easiest flight schedule" value="easiest-flight-schedule">Easiest flight schedule</option> <option label="Lowest price" value="lowest-price">Lowest price</option> </field> <field type="radio-group" label="Hotel Preference" name="hotel-preference" other="true"> <option label="Budget" value="budget">Budget</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 activities are you interested in?&nbsp;" description="Check all that apply" inline="true" name="activity-preferences" other="true"> <option label="Snorkeling " value="snorkeling-">Snorkeling </option> <option label="Scuba Diving" value="scuba-diving">Scuba Diving</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Hiking" value="hiking">Hiking</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Golf" value="golf">Golf</option> <option label="Tennis/Pickelball" value="tennispickelball">Tennis/Pickelball</option> <option label="Ziplining" value="ziplining">Ziplining</option> <option label="ATV/off-roading" value="atvoffroading">ATV/off-roading</option> <option label="Catamaran Sailing" value="catamaran-sailing">Catamaran Sailing</option> <option label="Fishing" value="fishing">Fishing</option> <option label="Museums" value="museums">Museums</option> <option label="Arts and theater" value="arts-and-theater">Arts and theater</option> <option label="Architecture" value="architecture">Architecture</option> <option label="Shopping" value="shopping">Shopping</option> </field> <field type="radio-group" required="true" label="I understand that it is vitally important that I read the information emailed to me by my advisor in order to be prepared for travel in the current climate. I also understand that I share the responsibility of remaining informed about the entry requirements for the destination(s) I am visiting. I will secure all necessary testing and complete all forms required for travel. Our terms &amp; conditions can be found at www.chelaxadventures.com/terms" name="radio-group-1663164376910"> <option label="I agree" value="i-agree">I agree</option> <option label="I do not agree" value="i-do-not-agree">I do not agree</option> </field> </fields> </form-template> </body> </html>
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