Share your information with Tanya Parker-Kittell

Tanya Parker-Kittell

Travel Bliss

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="checkbox-group" required="true" label="Country of Destination" name="country-of-destination">&#13;
			<option label="within the US" value="within-the-us">within the US</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="Caribbean" value="Caribbean">Caribbean</option>&#13;
			<option label="Central America (Ex. Costa Rica, Panama)" value="central-america-ex-costa-rica-panama">Central America (Ex. Costa Rica, Panama)</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="Africa" value="africa">Africa</option>&#13;
			<option label="Asia" value="asia">Asia</option>&#13;
			<option label="Middle East" value="middle-east">Middle East</option>&#13;
			<option label="Australia/New Zealand/Fiji" value="australianew-zealandfiji">Australia/New Zealand/Fiji</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Exact Location (Ex. Jamaica, Cancun, Aruba, etc...)" name="exact-location-ex-jamaica-cancun-aruba-etc" 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;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Is this a land or cruise vacation?" name="is-this-a-land-or-cruise-vacation">&#13;
			<option label="Land" value="land">Land</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Both" value="both">Both</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Are you deposit ready?" name="are-you-deposit-ready">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No, I/we need more time" value="no-iwe-need-more-time">No, I/we need more time</option>&#13;
			<option label="I'm just price shopping for later" value="im-just-price-shopping-for-later">I'm just price shopping for later</option>&#13;
		</field>&#13;
		<field type="text" required="true" 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" required="true" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="If you have kids traveling, put their ages. If none, type NONE" name="if-you-have-kids-traveling-put-their-ages-if-none-type-none" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Is this going to be a group trip? (over 6 adults)" name="is-this-going-to-be-a-group-trip-over-6-adults" className="form-control">&#13;
			<option label="--Select--" value="select">--Select--</option>&#13;
			<option label="Yes - we are all booking together" value="yes-we-are-all-booking-together">Yes - we are all booking together</option>&#13;
			<option label="Yes - but we'd like to book separately" value="yes-but-wed-like-to-book-separately">Yes - but we'd like to book separately</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What is your PER PERSON budget?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Would you like an All-Inclusive?" name="would-you-like-an-allinclusive">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="Doesn't matter" value="doesnt-matter">Doesn't matter</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="checkbox-group" 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="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</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;
		</field>&#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="Cruise Info - amount of days, destination, cruise line preference (if any), cabin class" name="cruise-info-amount-of-days-destination-cruise-line-preference-if-any-cabin-class" className="form-control"/>&#13;
		<field type="select" label="Rental Car?" name="rental-car" className="form-control">&#13;
			<option label="--Select--" value="select">--Select--</option>&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#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="Full 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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#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" label="Country" name="address-country" 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="Cell number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="How did you hear about Travel Bliss?" name="how-did-you-hear-about-travel-bliss" className="form-control">&#13;
			<option label="--SELECT--" value="select">--SELECT--</option>&#13;
			<option label="Friend" value="friend">Friend</option>&#13;
			<option label="Saw on social media" value="saw-on-social-media">Saw on social media</option>&#13;
			<option label="Google search" value="google-search">Google search</option>&#13;
		</field>&#13;
		<field type="text" label="Additional Notes" description="Provide any specifics you&#39;d like to include" name="additional-notes" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>