Hillary Barbati

AAA Western & Central NY

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Traveler Information"/>&#13;
		<field type="text" required="true" label="First name" name="first-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="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="text" required="true" label="How many&amp;nbsp; people are traveling?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How Many Children Are Traveling Below the Age of 15 years old?" name="how-many-children-are-traveling-below-the-age-of-15-years-old" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="If outside of the United States, does everyone have a passport that is expiring 6 months or greater from your return date?" name="passport-expiring">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Not Yet" value="not-yet">Not Yet</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Do any travelers have allergies or accommodation needs that I should be aware of?" name="allergies" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Trip Information"/>&#13;
		<field type="select" required="true" label="Is this vacation to celebrate anything special?" description="Select the reason for your trip" name="reason-for-trip" className="form-control">&#13;
			<option label="Family Vacation" value="family-vacation">Family Vacation</option>&#13;
			<option label="Wedding" value="wedding">Wedding</option>&#13;
			<option label="Girls Trip/Boys Trip" value="girls-tripboys-trip">Girls Trip/Boys Trip</option>&#13;
			<option label="Romantic Getaway" value="romantic-getaway">Romantic Getaway</option>&#13;
			<option label="Birthday/Anniversary/Graduation" value="birthdayanniversarygraduation">Birthday/Anniversary/Graduation</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" required="true" 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"/>&#13;
		<field type="text" required="true" label="When would you like to travel?&amp;nbsp;&amp;nbsp;" description="Give me an idea of when you're hoping to travel, for how many days etc." name="when-would-you-like-to-travel-" subtype="text" 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;
		</field>&#13;
		<field type="text" label="What is your departure city?" name="what-is-your-departure-city" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your estimated budget for all travelers?&amp;nbsp; (This just gives me a starting point and can always be changed later.)" name="what-is-your-estimated-budget-for-all-travelers-this-just-gives-me-a-starting-point-and-can-always-be-changed-later">&#13;
			<option label="$3,000-$5,000" value="30005000">$3,000-$5,000</option>&#13;
			<option label="$5,000-$7,000" value="50007000">$5,000-$7,000</option>&#13;
			<option label="$7,000-$10,000" value="700010000">$7,000-$10,000</option>&#13;
			<option label="$10,000-$15,000" value="1000015000">$10,000-$15,000</option>&#13;
			<option label="$15,000+" value="15000">$15,000+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Which travel components would you like assistance with?" name="which-travel-components-would-you-like-assistance-with">&#13;
			<option label="Flights" value="flights" selected="selected">Flights</option>&#13;
			<option label="Accommodations" value="accommodations">Accommodations</option>&#13;
			<option label="Car Rental" value="car-rental">Car Rental</option>&#13;
			<option label="Excursions/Tours" value="excursionstours">Excursions/Tours</option>&#13;
			<option label="Travel Insurance" value="travel-insurance">Travel Insurance</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your desired accommodation style?" name="hotel-preference" other="true">&#13;
			<option label="Value" value="economy" selected="selected">Value</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Deluxe/Luxury" value="luxury">Deluxe/Luxury</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Site Seeing (local attractions)" value="site-seeing-local-attractions">Site Seeing (local attractions)</option>&#13;
			<option label="Scuba / Water Activities" value="scuba-water-activities">Scuba / Water Activities</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
			<option label="None" value="none">None</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know about your ideal vacation?&amp;nbsp;" name="notes" className="form-control"/>&#13;
		<field type="text" label="Who can I thank for referring you to us?" name="who-can-i-thank-for-referring-you-to-us" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Would you like to be subscribed to our company newsletter?&amp;nbsp;" name="would-you-like-to-be-subscribed-to-our-company-newsletter-" className="form-control">&#13;
			<option label="Yes please!" value="yes-please" selected="selected">Yes please!</option>&#13;
			<option label="No, thank you" value="no-thank-you">No, thank you</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>