Share your information with Daria Dimitroff

Daria Dimitroff

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="TRIP DESIGN FORM"/>&#13;
		<field type="header" subtype="h1" label="Name"/>&#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="I prefer to be addressed as:" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Address &amp;amp; Contact Information"/>&#13;
		<field type="text" required="true" 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" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" 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="Mobile phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Home phone number" name="home-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Do you have a preferred phone number?" name="do-you-have-a-preferred-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Trip Information"/>&#13;
		<field type="text" required="true" label="Who will be traveling with you on this trip? Please provide ages and relationship to you." name="who-will-be-traveling-with-you-on-this-trip-please-provide-ages-and-relationship-to-you" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" 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" required="true" 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" required="true" 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" required="true" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Maybe" value="maybe">Maybe</option>&#13;
		</field>&#13;
		<field type="text" label="How many nights would you like the entire vacation to be?" name="how-many-nights-would-you-like-the-entire-vacation-to-be" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What type of trip to you have in mind? In other words, how do you want this trip to make you feel, and what are you trying to get out of it?" name="what-type-of-trip-to-you-have-in-mind-in-other-words-how-do-you-want-this-trip-to-make-you-feel-and-what-are-you-trying-to-get-out-of-it" className="form-control"/>&#13;
		<field type="textarea" required="true" label="How do you want to spend your time on this vacation? What types of things would you like to do?" name="how-do-you-want-to-spend-your-time-on-this-vacation-what-types-of-things-would-you-like-to-do" className="form-control"/>&#13;
		<field type="checkbox-group" label="What other activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="History and culture" value="history-and-culture">History and culture</option>&#13;
			<option label="Museums &amp; Galleries" value="museums-galleries">Museums &amp; Galleries</option>&#13;
			<option label="Food and Wine" value="food-and-wine">Food and Wine</option>&#13;
			<option label="Theater" value="theater">Theater</option>&#13;
			<option label="Spa" value="spa">Spa</option>&#13;
			<option label="Shopping" value="shopping">Shopping</option>&#13;
			<option label="Beach and Water" value="beach-and-water">Beach and Water</option>&#13;
			<option label="Adventure Activities" value="adventure-activities">Adventure Activities</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
		</field>&#13;
		<field type="textarea" label="Is there anything you absolutely must do or see?" name="what-are-your-interests-and-hobbies-and-the-interests-and-hobbies-of-your-travel-companions" className="form-control"/>&#13;
		<field type="textarea" label="What are your interests and hobbies and those of your travel companions?" name="what-are-your-interests-and-hobbies-and-those-of-your-travel-companions" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#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="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="LGBTQ+" value="lgbtq">LGBTQ+</option>&#13;
		</field>&#13;
		<field type="textarea" label="Is there anything you want to avoid on this trip?" name="is-there-anything-you-want-to-avoid-on-this-trip" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What would you like my help with? (I only handle entire trips from top to bottom. I do not handle only bits and pieces of trips or certain parts of trips.)" name="what-would-you-like-my-help-with-i-only-handle-entire-trips-from-top-to-bottom-i-do-not-handle-only-bits-and-pieces-of-trips-or-certain-parts-of-trips" other="true">&#13;
			<option label="Figuring out where to go" value="figuring-out-where-to-go">Figuring out where to go</option>&#13;
			<option label="Planning how long to spend in each place" value="planning-how-long-to-spend-in-each-place">Planning how long to spend in each place</option>&#13;
			<option label="Figuring how to get from place to place during the trip" value="figuring-how-to-get-from-place-to-place-during-the-trip">Figuring how to get from place to place during the trip</option>&#13;
			<option label="Accommodations" value="accommodations">Accommodations</option>&#13;
			<option label="Activities and/or tours" value="activities-andor-tours">Activities and/or tours</option>&#13;
			<option label="Restaurants" value="restaurants">Restaurants</option>&#13;
			<option label="Transportation to and from airports and accommodations" value="transportation-to-and-from-airports-and-accommodations">Transportation to and from airports and accommodations</option>&#13;
			<option label="All of the above" value="all-of-the-above">All of the above</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Moderate (4 Star)" value="moderate-4-star">Moderate (4 Star)</option>&#13;
			<option label="Luxury (5 star)" value="luxury-5-star">Luxury (5 star)</option>&#13;
			<option label="Ultra Luxury (5+++ star)" value="ultra-luxury-5-star">Ultra Luxury (5+++ star)</option>&#13;
			<option label="Boutique (4 - 5 star)" value="boutique-4-5-star">Boutique (4 - 5 star)</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What is your preferred price range for this trip trip (not including meals)? Most people aren&#39;t sure, so just give your best estimate." description="I usually don&#39;t handle trips for less than $10k although many trips require a higher budget. The necessary budget for each trip varies a lot (depending on dates, number of travelers, length of trip, etc.) but I will discuss this with you when we speak. " name="what-budget-do-you-not-want-to-exceed-on-this-trip-not-including-meals-i-dont-handle-trips-for-less-than-10k-and-i-dont-handle-low-budget-trips-the-budget-required-for-each-trip-varies-a-lot-depending-on-dates-number-of-travelers-length-of-trip-etc-but-i-will-discuss-this-with-you-when-we-speak-most-people-dont-know-what-their-budget-should-be-so-just-give-your-best-estimate" className="form-control">&#13;
			<option label="" value=""/>&#13;
			<option label="$10,000 - $20,000" value="10000-20000">$10,000 - $20,000</option>&#13;
			<option label="$21,000 - $35,000" value="21000-35000">$21,000 - $35,000</option>&#13;
			<option label="$36,000 - $50,000" value="36000-50000">$36,000 - $50,000</option>&#13;
			<option label="$51,000 - $65,000" value="51000-65000">$51,000 - $65,000</option>&#13;
			<option label="$66,000 - $80,000" value="66000-80000">$66,000 - $80,000</option>&#13;
			<option label="$81,000 - $100,000" value="81000-100000">$81,000 - $100,000</option>&#13;
			<option label="over $100,000" value="over-100000">over $100,000</option>&#13;
		</field>&#13;
		<field type="textarea" label="Is there anything else you would like me to know?" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
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