Share your information with Mallory Jones

Mallory Jones

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<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Change the way you travel forever. Your travel membership awaits."/>&#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="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" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="How much do you invest in travel annually?" placeholder="Select an option" name="how-much-do-you-invest-in-travel-annually" className="form-control">&#13;
			<option label="&lt;$10,000" value="10000">&lt;$10,000</option>&#13;
			<option label="$10,000-$25,000" value="1000025000">$10,000-$25,000</option>&#13;
			<option label="$25,000-$50,000" value="2500050000">$25,000-$50,000</option>&#13;
			<option label="$50,000-$100,000" value="50000100000">$50,000-$100,000</option>&#13;
			<option label="$100,000-$200,000" value="100000200000">$100,000-$200,000</option>&#13;
			<option label="&gt;$250,000" value="250000">&gt;$250,000</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="How many trips do you take annually?" placeholder="Select an option" name="how-many-trips-do-you-take-annually" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5-10" value="510">5-10</option>&#13;
			<option label="&gt;10" value="10">&gt;10</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Which of the following services do you typically need assistance with?" placeholder="Select an option" name="which-of-the-following-services-do-you-typically-need-assistance-with" className="form-control">&#13;
			<option label="Accommodations" value="accommodations">Accommodations</option>&#13;
			<option label="Private Guides" value="private-guides">Private Guides</option>&#13;
			<option label="Special Experiences" value="special-experiences">Special Experiences</option>&#13;
			<option label="Curated Dining" value="curated-dining">Curated Dining</option>&#13;
			<option label="Local Recommendations" value="local-recommendations">Local Recommendations</option>&#13;
			<option label="Itinerary and Logistics Consulting" value="itinerary-and-logistics-consulting">Itinerary and Logistics Consulting</option>&#13;
			<option label="Destination Consulting" value="destination-consulting">Destination Consulting</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What do you typically spend on accommodations (per room/per night)?" placeholder="Select an option" name="what-do-you-typically-spend-on-accommodations-per-roomper-night" className="form-control">&#13;
			<option label="&lt;$500" value="500">&lt;$500</option>&#13;
			<option label="$500-$1,000" value="5001000">$500-$1,000</option>&#13;
			<option label="$1,000-$1,500" value="10001500">$1,000-$1,500</option>&#13;
			<option label="$1,500-$2,000" value="15002000">$1,500-$2,000</option>&#13;
			<option label="$2,000-$2,500" value="20002500">$2,000-$2,500</option>&#13;
			<option label="$2,500+" value="2500">$2,500+</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Who do you travel with?" placeholder="Select an option" name="who-do-you-travel-with" className="form-control">&#13;
			<option label="Myself" value="myself">Myself</option>&#13;
			<option label="My Partner" value="my-partner">My Partner</option>&#13;
			<option label="My Family" value="my-family">My Family</option>&#13;
			<option label="My Friends" value="my-friends">My Friends</option>&#13;
			<option label="My Company" value="my-company">My Company</option>&#13;
			<option label="A Mix" value="a-mix">A Mix</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="How did you hear about us?" name="how-did-you-hear-about-us">&#13;
			<option label="Existing Client" value="existing-client">Existing Client</option>&#13;
			<option label="Employee/IC Referral" value="employeeic-referral">Employee/IC Referral</option>&#13;
			<option label="Family/Friend" value="familyfriend">Family/Friend</option>&#13;
			<option label="Search Engine (Google, i.e.)" value="search-engine-google-ie">Search Engine (Google, i.e.)</option>&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Article/Blog" value="articleblog">Article/Blog</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>