Share your information with Amanda Cotton

Amanda Cotton

TH Travel Designs

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#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 required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="List each traveler&#39;s full legal name and date of birth" name="textarea-1782835000609" className="form-control"/>&#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="checkbox-group" label="Would you like assistance booking flights?" name="checkbox-group-1782838218914">&#13;
			<option label="Yes, please help" value="yes-please-help" selected="selected">Yes, please help</option>&#13;
			<option label="No, I will book with my own points" value="no-i-will-book-with-my-own-points">No, I will book with my own points</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Are all travelers&#39; passports current and valid for at least six months beyond your return date for this trip?" name="checkbox-group-1782835112056">&#13;
			<option label="Yes, all are up to date." value="yes-all-are-up-to-date" selected="selected">Yes, all are up to date.</option>&#13;
			<option label="No, need to apply or renew." value="no-need-to-apply-or-renew">No, need to apply or renew.</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" 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">&#13;
			<option label="$5,000-$7,000" value="50007000">$5,000-$7,000</option>&#13;
			<option label="$7,000-$10,000" value="700010000">$7,000-$10,000</option>&#13;
			<option label="$10,000-$15,000" value="1000015000">$10,000-$15,000</option>&#13;
			<option label="$15,000-$20,000" value="1500020000">$15,000-$20,000</option>&#13;
			<option label="$20,000-$30,000" value="2000030000">$20,000-$30,000</option>&#13;
			<option label="$30,000-$40,000" value="3000040000">$30,000-$40,000</option>&#13;
			<option label="$50,000 +" value="50000-">$50,000 +</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="History" value="history">History</option>&#13;
			<option label="Foodie" value="foodie">Foodie</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="Are there dietary restrictions or mobility concerns?" name="textarea-1782838418309" className="form-control"/>&#13;
		<field type="textarea" label="Are you celebrating anything special for this trip?" 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="pageBreak" name="pageBreak-1782834865627" next="Next" previous="Previous"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>