<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="TELL ME ABOUT YOUR TRIP"/> <field type="radio-group" label="Which Travel Agent would you like to work with?" inline="true" name="which-travel-agent-would-you-like-to-work-with"> <option label="Jovoanda Reed" value="jovoanda-reed">Jovoanda Reed</option> <option label="Robin Kennedy" value="robin-kennedy">Robin Kennedy</option> <option label="Alia Freeman" value="alia-freeman">Alia Freeman</option> </field> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-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" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="radio-group" label="Are you celebrating a special occasion?" name="are-you-celebrating-a-special-occasion" other="true"> <option label="Birthday" value="birthday">Birthday</option> <option label="Engagement" value="engagement">Engagement</option> <option label="Honeymoon" value="honeymoon">Honeymoon</option> <option label="Anniversary" value="anniversary">Anniversary</option> <option label="Retirement Celebration" value="retirement-celebration">Retirement Celebration</option> <option label="Summer Break" value="summer-break">Summer Break</option> <option label="Spring Break" value="spring-break">Spring Break</option> <option label="Family Vacation" value="family-vacation">Family Vacation</option> <option label="Family Reunion" value="family-reunion">Family Reunion</option> <option label="Bachelor Party" value="bachelor-party">Bachelor Party</option> <option label="Bachelorette Party" value="bachelorette-party">Bachelorette Party</option> <option label="Graduation" value="graduation">Graduation</option> </field> <field type="radio-group" required="true" label="What is your budget per person?" name="what-is-your-budget-per-person"> <option label="up to $1000" value="up-to-1000">up to $1000</option> <option label="$1000 - $1500" value="1000-1500">$1000 - $1500</option> <option label="$1500 - $2500" value="1500-2500">$1500 - $2500</option> <option label="$2500 - $4000" value="2500-4000">$2500 - $4000</option> <option label="$4000+" value="4000">$4000+</option> </field> <field type="radio-group" required="true" label="Do you have a passport?" name="do-you-have-a-passport"> <option label="Yes" value="yes">Yes</option> <option label="No, waiting to receive it" value="no-waiting-to-receive-it">No, waiting to receive it</option> <option label="Need to apply for one" value="need-to-apply-for-one">Need to apply for one</option> </field> <field type="radio-group" required="true" label="When are you expecting to book by submitting your deposit?" description="Note the pricing can change without a deposit being paid" name="when-are-you-expecting-to-book-by-submitting-your-deposit"> <option label="ASAP" value="asap">ASAP</option> <option label="Within 3-5 days" value="within-35-days">Within 3-5 days</option> <option label="With 2 weeks" value="with-2-weeks">With 2 weeks</option> <option label="I'm not sure " value="im-not-sure-">I'm not sure </option> </field> <field type="header" subtype="h1" label="RESORT INFORMAITON"/> <field type="text" label="Is there a specific resort you are most interested in?" placeholder="i.e. RIU Sandals Hyatt Zilara Breathless" name="is-there-a-specific-resort-you-are-most-interested-in" subtype="text" className="form-control"/> <field type="text" required="true" label="Where do you want to go?" placeholder="i.e. The Bahamas Mexico Jamaica" name="where-do-you-want-to-go" subtype="text" className="form-control"/> <field type="text" required="true" label="Preferred Departure Airport" placeholder="i.e. ATL LGA MIA" name="preferred-departure-airport" subtype="text" className="form-control"/> <field type="text" label="Do you have an airline preference?" placeholder="i.e. Delta Spirit American Southwest" name="do-you-have-an-airline-preference" subtype="text" className="form-control"/> <field type="text" required="true" label="What dates? Do you have specific dates in mind or a time frame?" placeholder="i.e. June 2023" name="what-dates-do-you-have-specific-dates-in-mind-or-a-time-frame" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="How many days would you like the trip to be?" name="how-many-days-would-you-like-the-trip-to-be"> <option label="3 days" value="3-days">3 days</option> <option label="4 days" value="4-days">4 days</option> <option label="5 days" value="5-days">5 days</option> <option label="6 days" value="6-days">6 days</option> <option label="7 days " value="7-days-">7 days </option> <option label="8+ days" value="8-days">8+ days</option> </field> <field type="text" required="true" label="How many guests total will be traveling?" name="how-many-guests-total-will-be-traveling" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="How many rooms will you need?" name="how-many-rooms-will-you-need"> <option label="1" value="1">1</option> <option label="2" value="2">2</option> <option label="3" value="3">3</option> <option label="4" value="4">4</option> <option label="5+" value="5">5+</option> </field> <field type="radio-group" label="What type of room would you like?" name="what-type-of-room-would-you-like"> <option label="Ocean Front" value="ocean-front">Ocean Front</option> <option label="Ocean View" value="ocean-view">Ocean View</option> <option label="Balcony" value="balcony">Balcony</option> <option label="Garden View" value="garden-view">Garden View</option> <option label="Pool View" value="pool-view">Pool View</option> <option label="Swim-Up" value="swimup">Swim-Up</option> </field> <field type="text" label="Are there any medical issues/needs we need to be aware of?" placeholder="i.e. accessible cabin needed autism allergies" name="are-there-any-medical-issuesneeds-we-need-to-be-aware-of" subtype="text" className="form-control"/> <field type="checkbox-group" label="Would you like to add the following after booking?" toggle="true" name="would-you-like-to-add-the-following-after-booking"> <option label="Specialty Dining" value="specialty-dining">Specialty Dining</option> <option label="Excursions" value="excursions">Excursions</option> <option label="Travel Insurance" value="travel-insurance">Travel Insurance</option> <option label="VIP Experience (if applicable)" value="vip-experience-if-applicable">VIP Experience (if applicable)</option> <option label="Round Trip Transfers" value="round-trip-transfers">Round Trip Transfers</option> <option label="Private Transportation" value="private-transportation">Private Transportation</option> </field> <field type="radio-group" label="Referred by:" name="referred-by"> <option label="Previous Client" value="previous-client">Previous Client</option> <option label="Google Search" value="google-search">Google Search</option> <option label="Facebook" value="facebook">Facebook</option> <option label="Instagram" value="instagram">Instagram</option> <option label="Other advertisement" value="other-advertisement">Other advertisement</option> </field> <field type="header" subtype="h1" label="SPECIAL REQUEST"/> <field type="checkbox-group" label="Medical" toggle="true" name="medical"> <option label="Allergies" value="allergies">Allergies</option> <option label="B-Pap" value="bpap">B-Pap</option> <option label="Blind/Low Vision (kits)" value="blindlow-vision-kits">Blind/Low Vision (kits)</option> <option label="C-Pap" value="cpap">C-Pap</option> <option label="Deaf/Hard of Hearing (kits)" value="deafhard-of-hearing-kits">Deaf/Hard of Hearing (kits)</option> <option label="Diabetic" value="diabetic">Diabetic</option> <option label="Hearing (Interpreter)" value="hearing-interpreter">Hearing (Interpreter)</option> <option label="Motorized Scooter" value="motorized-scooter">Motorized Scooter</option> <option label="Oxygen" value="oxygen">Oxygen</option> <option label="Pregnancy" value="pregnancy">Pregnancy</option> <option label="Service Animal" value="service-animal">Service Animal</option> <option label="Sharps Disposal - In Cabin" value="sharps-disposal-in-cabin">Sharps Disposal - In Cabin</option> <option label="Wheelchair" value="wheelchair">Wheelchair</option> </field> </fields> </form-template> </body> </html>
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