Share your information with Erin Popper

Erin Popper

Jen Mitchell Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="General Information"/>&#13;
		<field type="text" label="How did you hear about us?" name="text-1774547472944" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Preferred Method of Contact" name="checkbox-group-1774548349503">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Any" value="any">Any</option>&#13;
		</field>&#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" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="text" label="Where would you like to go?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" 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" 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;
		</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="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Have you worked with a Travel Advisor before?" name="select-1774548000187" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" label="The way I previously planned my travel was:&amp;nbsp;" name="select-1774547696384" className="form-control">&#13;
			<option label="Doing endless amounts of research and selecting only after careful consideration." value="doing-endless-amounts-of-research-and-selecting-only-after-careful-consideration">Doing endless amounts of research and selecting only after careful consideration.</option>&#13;
			<option label="Last-minute with little consistency in the method I booked." value="lastminute-with-little-consistency-in-the-method-i-booked">Last-minute with little consistency in the method I booked.</option>&#13;
			<option label="My personal assistant planned my travel." value="my-personal-assistant-planned-my-travel">My personal assistant planned my travel.</option>&#13;
			<option label="Online travel agencies like Expedia or Hotels.com" value="online-travel-agencies-like-expedia-or-hotelscom">Online travel agencies like Expedia or Hotels.com</option>&#13;
			<option label="Direct on the hotel's website and using their concierge service." value="direct-on-the-hotels-website-and-using-their-concierge-service">Direct on the hotel's website and using their concierge service.</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="By using a travel advisor, I am hoping to:" name="checkbox-group-1774548594801">&#13;
			<option label="Save time and leave the trip planning up to an expert." value="save-time-and-leave-the-trip-planning-up-to-an-expert">Save time and leave the trip planning up to an expert.</option>&#13;
			<option label="Collaborate with my advisor to add value and enriching experiences to my vacation." value="collaborate-with-my-advisor-to-add-value-and-enriching-experiences-to-my-vacation">Collaborate with my advisor to add value and enriching experiences to my vacation.</option>&#13;
			<option label="Get the best deals out there." value="get-the-best-deals-out-there">Get the best deals out there.</option>&#13;
			<option label="Gain access to amenities like upgrades, resort credits and complimentary breakfast that I can't get on my own." value="gain-access-to-amenities-like-upgrades-resort-credits-and-complimentary-breakfast-that-i-cant-get-on-my-own">Gain access to amenities like upgrades, resort credits and complimentary breakfast that I can't get on my own.</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget" other="true">&#13;
			<option label="$1,500 to $5000" value="1500-to-5000">$1,500 to $5000</option>&#13;
			<option label="$5,000 to 10,000" value="5000-to-10000">$5,000 to 10,000</option>&#13;
			<option label="10,000 to 20,000" value="10000-to-20000">10,000 to 20,000</option>&#13;
			<option label="20,000 to 30,000" value="20000-to-30000">20,000 to 30,000</option>&#13;
			<option label="30,000 to 40,000" value="30000-to-40000">30,000 to 40,000</option>&#13;
			<option label="I have an unlimited budget for the trip of my dreams" value="i-have-an-unlimited-budget-for-the-trip-of-my-dreams">I have an unlimited budget for the trip of my dreams</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What best describes your hotel preference?" name="checkbox-group-1774548658756" other="true">&#13;
			<option label="Brand names like Four Seasons, Aman, Ritz Carlton and Rosewood Hotels" value="brand-names-like-four-seasons-aman-ritz-carlton-and-rosewood-hotels">Brand names like Four Seasons, Aman, Ritz Carlton and Rosewood Hotels</option>&#13;
			<option label="Small luxury boutique hotels" value="small-luxury-boutique-hotels">Small luxury boutique hotels</option>&#13;
			<option label="Nice hotels, but not necessarily 5 star hotels" value="nice-hotels-but-not-necessarily-5-star-hotels">Nice hotels, but not necessarily 5 star hotels</option>&#13;
			<option label="All-Inclusive so that I know what my all-in cost is up front" value="allinclusive-so-that-i-know-what-my-allin-cost-is-up-front">All-Inclusive so that I know what my all-in cost is up front</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="text" label="Are you celebrating something special?" name="text-1774548205056" subtype="text" className="form-control"/>&#13;
		<field type="date" label="If so, what is the exact date of the celebration?" name="date-1774548230563" className="form-control"/>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Airfare"/>&#13;
		<field type="checkbox-group" label="Will you require air travel assistance?" name="checkbox-group-1774548282471">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="If you were referred by someone, please let us know so we can thank them!" name="text-1774548724632" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>