Share your information with JAQUAY YOUNG EL

JAQUAY YOUNG EL

YOUNG LIFESTYLE TRAVEL

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>&#13;
		<field type="text" required="true" label="Trip Name&amp;nbsp;" description="Example: Tammy&#39;s Jamaican Bday Bash" name="text-1787320143153" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Which resort/stay/cruise did you pick?" name="text-1785967263961" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Departure City" name="text-1787323521875" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Destination" name="text-1785967499246" 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="text" required="true" label="Estimated Crew Size" description="How many people you know will be going for sure?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is the per person budget for all travelers?" description="Includes Flights  ground transportation and more" name="budget" other="true" className="radio-group">&#13;
			<option label="Under $1500" value="under-1500">Under $1500</option>&#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="text" required="true" label="Your First Name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Your Birthday" name="birthday" 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;
	</fields>&#13;
</form-template>
  </body>
</html>