Share your information with Trinette Mitchell

Trinette Mitchell

Premiere Destinations Travel, LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full Name, Number &amp;amp; Email"/>&#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="Preferred email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Preferred phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Basic Travel Info"/>&#13;
		<field type="text" required="true" label="When are you looking to travel?" name="when-are-you-looking-to-travel" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Do you have any dates in mind?" name="do-you-have-any-dates-in-mind" className="form-control"/>&#13;
		<field type="select" required="true" label="What region are you traveling to? Or would you prefer a cruise?" name="what-region-are-you-traveling-to-or-would-you-prefer-a-cruise" multiple="multiple" className="form-control">&#13;
			<option label="USA" value="usa" selected="selected">USA</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="Asia" value="asia">Asia</option>&#13;
			<option label="Africa" value="africa">Africa</option>&#13;
			<option label="Middle East" value="middle-east">Middle East</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
		</field>&#13;
		<field type="text" label="What city in your preferred region are you traveling to?" name="what-city-in-your-preferred-region-are-you-traveling-to" subtype="text" className="form-control"/>&#13;
		<field type="select" label="If cruising, where would you like to cruise to?" name="if-cruising-where-would-you-like-to-cruise-to" multiple="multiple" className="form-control">&#13;
			<option label="The Caribbean" value="the-caribbean" selected="selected">The Caribbean</option>&#13;
			<option label="Bahamas" value="bahamas">Bahamas</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="Asia" value="asia">Asia</option>&#13;
			<option label="Australia" value="australia">Australia</option>&#13;
			<option label="French Polynesia" value="french-polynesia">French Polynesia</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="How many people will be traveling?" name="how-many-people-will-be-traveling" className="form-control">&#13;
			<option label="1" value="1" selected="selected">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4 or more" value="4-or-more">4 or more</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>