Share your information with Geoffrey Koester

Geoffrey Koester

Travel With Geoffrey

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="New Trip Request"/>&#13;
		<field type="paragraph" subtype="p" label="Ready to travel? Complete this form with all the applicable information for your desired trip and I&#39;ll get to work on planning it all out for you. You can expect an email reply back within typically 24-48 hours after submitting this form."/>&#13;
		<field type="paragraph" subtype="p" label="Note that some questions/options may not apply to your specific trip, so it&#39;s okay to leave those blank. Required fields are the only ones all travel clients must complete. If there&#39;s more information or questions you have that don&#39;t fit on this form, you can always email me as well."/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#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="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" 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" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Your Birthday" name="your-birthday" className="form-control"/>&#13;
		<field type="textarea" label="List out all other members of your travel party (adults and kids). Include full names and birth dates. If anyone has a different address than yours provided, please provide that as well." description="This is very important information as it will be used on your bookings!" name="list-out-all-other-members-of-your-travel-party-adults-and-kids-include-full-names-and-birth-dates-if-anyone-has-a-different-address-than-yours-provided-please-provide-that-as-well" rows="3" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Trip Specifics"/>&#13;
		<field type="radio-group" required="true" label="What type of trip are you looking to book?" description="Select what most applies  and add details further down!" name="what-type-of-trip-are-you-looking-to-book" other="true">&#13;
			<option label="Walt Disney World" value="walt-disney-world">Walt Disney World</option>&#13;
			<option label="Universal Orlando" value="universal-orlando">Universal Orlando</option>&#13;
			<option label="Disneyland California" value="disneyland-california">Disneyland California</option>&#13;
			<option label="Universal Studios Hollywood" value="universal-studios-hollywood">Universal Studios Hollywood</option>&#13;
			<option label="Disney Cruise" value="disney-cruise">Disney Cruise</option>&#13;
			<option label="Virgin Voyages Cruise" value="virgin-voyages-cruise">Virgin Voyages Cruise</option>&#13;
			<option label="Other Cruise" value="other-cruise">Other Cruise</option>&#13;
			<option label="All Inclusive Resort" value="all-inclusive-resort">All Inclusive Resort</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Please elaborate on what type of trip you are looking for!" description="Use this space to share if you&#39;d like to do multiple theme parks (i.e. Disney and Universal)  what other activities you&#39;re interested in  and/or what type of cruise or other destination you&#39;d like." name="please-elaborate-on-what-type-of-trip-you-are-looking-for" rows="5" 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="text" label="Are your dates flexible? If so, please elaborate how they are flexible (earlier, later, etc)." name="if-your-dates-are-flexible-please-elaborate-how-they-are-flexible-earlier-later-etc" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your departure city/airport?" description="If flying  include your preferred airport code(s)!" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="radio-group" label="Seat preference" description="If flying!" name="seat-preference">&#13;
			<option label="Window" value="window">Window</option>&#13;
			<option label="Aisle" value="aisle">Aisle</option>&#13;
			<option label="Opposite aisle" value="opposite aisle">Opposite aisle</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy/Value" value="economyvalue">Economy/Value</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury/Deluxe" value="luxurydeluxe">Luxury/Deluxe</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" description="For hotel bookings - don&#39;t worry about travel party size  I&#39;ll make it work!" name="bed-preference" other="true">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
		</field>&#13;
		<field type="text" label="Meal preferences/dietary restrictions?" description="Include favorite foods as well as any dietary restrictions!" name="meal-preference" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Vibe preferences" name="vibe-preference">&#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;
			<option label="Multi-generational" value="multi-generational">Multi-generational</option>&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
			<option label="LGBT" value="lgbt">LGBT</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Activity preferences" name="activity-preferences">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Theme Parks" value="theme-parks">Theme Parks</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 theatre" value="art-theatre">Arts and theatre</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers/the full trip?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="Very budget conscious/friendly" value="very-budget-consciousfriendly">Very budget conscious/friendly</option>&#13;
			<option label="Middle of the road - I want my money's worth, but willing to spend" value="middle-of-the-road-i-want-my-moneys-worth-but-willing-to-spend">Middle of the road - I want my money's worth, but willing to spend</option>&#13;
			<option label="I want luxury and I'm willing to pay for it" value="i-want-luxury-and-im-willing-to-pay-for-it">I want luxury and I'm willing to pay for it</option>&#13;
		</field>&#13;
		<field type="text" label="If you have a specific dollar amount for your total budget, please provide it here." description="I will stay within whatever you number you give here!" name="if-you-have-a-specific-dollar-amount-for-your-total-budget-please-provide-it-here" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Final Details"/>&#13;
		<field type="radio-group" required="true" label="What level of service and support are you looking for with this trip?" name="what-level-of-service-and-support-are-you-looking-for-with-this-trip">&#13;
			<option label="I need lots of help, teach me everything" value="i-need-lots-of-help-teach-me-everything">I need lots of help, teach me everything</option>&#13;
			<option label="I know what I want, but don't want the hassle of booking any of it" value="i-know-what-i-want-but-dont-want-the-hassle-of-booking-any-of-it">I know what I want, but don't want the hassle of booking any of it</option>&#13;
			<option label="I know what I want and can handle the details, I just want to book with you" value="i-know-what-i-want-and-can-handle-the-details-i-just-want-to-book-with-you">I know what I want and can handle the details, I just want to book with you</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What stage of planning are you at with this trip?" name="what-stage-of-planning-are-you-at-with-this-trip">&#13;
			<option label="I'm ready to book" value="im-ready-to-book">I'm ready to book</option>&#13;
			<option label="I'm exploring options" value="im-exploring-options">I'm exploring options</option>&#13;
		</field>&#13;
		<field type="textarea" label="Does anyone in your party have mobility or disabilty concerns that will impact your trip? If yes, please explain." name="does-anyone-in-your-party-have-mobility-or-disabilty-concerns-that-will-impact-your-trip-if-yes-please-explain" rows="3" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What are your top priorities for this trip? Must dos/sees? Favorite attractions/dining? Purpose/reason for taking this trip?" name="what-are-your-top-priorities-for-this-trip-must-dossees-favorite-attractionsdining-purposereason-for-taking-this-trip" rows="3" className="form-control"/>&#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="text" required="true" label="Please type &#39;I agree&#39; below to show you have read, understand, and agree to the Terms &amp;amp; Conditions that I and Travelmation, LLC have in place for travel bookings. You can view these at https://geoffrey.travel/terms&amp;nbsp;" name="terms" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Credit Card Authorization: I authorize my Travelmation Travel Advisor to use my credit or debit card on my behalf for approved purchases related to, and only for, booking purposes. My travel advisor may store my credit card information in a secure client profile in case of multiple vacation components. My information will be deleted from the client profile after the travel period unless I request otherwise. I understand that all transactions are subject to the cancellation and refund policies and fees of individual vendors and it is my responsibility to be aware of those as applicable." description="You will not need to provide payment details until time of booking." name="authorization" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>