Share your information with Kerry Shane

Kerry Shane

Travelmation

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	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h1" label="Your Info - Not shared Publicly"/>&#13;
		<field type="text" required="true" label="First Name" name="text-1772310754664" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last Name" name="text-1772310758159" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="text-1772310759065" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Provide a review of your experience and help other travelers learn from the service you received from Kerry.&amp;nbsp; Please take into account all phases of the process when writing your review."/>&#13;
		<field type="select" required="true" label="Using a 1 to 5 scale, please rate this agent (1=poor, 5=excellent)" name="select-1772310926033" className="form-control">&#13;
			<option label="5 stars" value="5-stars">5 stars</option>&#13;
			<option label="4 stars" value="4-stars">4 stars</option>&#13;
			<option label="3 stars" value="3-stars">3 stars</option>&#13;
			<option label="2 stars" value="2-stars">2 stars</option>&#13;
			<option label="1 star" value="1-star">1 star</option>&#13;
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		<field type="checkbox-group" required="true" label="Would you recommend this agent to a friend or family member?" name="checkbox-group-1772311001596">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Please review your experience working with Kerry" name="textarea-1772311036588" className="form-control"/>&#13;
		<field type="text" required="true" label="Review Title&amp;nbsp;" placeholder="ex. The best trip of our lives!" name="text-1772311065186" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Your Nickname (Displays with your review)" name="text-1772311114622" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Info For Me Only"/>&#13;
		<field type="textarea" label="What are some areas I could grow as a travel advisor that would enable me to help you better?" name="textarea-1772311150494" className="form-control"/>&#13;
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