Share your information with Chrissy Selser

Chrissy Selser

Nova Travel Collective

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Let&#39;s get started with a few questions..."/>&#13;
		<field type="text" required="true" label="Legal first name (as it would appear on your ID or Passport)" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name (Nickname)" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Legal last name (as it appears on your ID or Passport)" name="last-name" 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="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Preferred Method of Communication:" name="preferred-method-of-communication" other="true">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone Call" value="phone-call">Phone Call</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
		</field>&#13;
		<field type="text" label="Any additional emails you would like me to use in communication?&amp;nbsp; Please list here." name="any-additional-emails-you-would-like-me-to-use-in-communication-please-list-here" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Names of all travelers and Dates of Birth" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="select" label="If traveling Internationally, does everyone have a passport that is valid for at least six months after the travel return date?" name="if-traveling-internationally-does-everyone-have-a-passport-that-is-valid-for-at-least-six-months-after-the-travel-return-date" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="I think so, but I need to double check the expiration dates" value="i-think-so-but-i-need-to-double-check-the-expiration-dates">I think so, but I need to double check the expiration dates</option>&#13;
			<option label="Not yet, we're planning on applying soon" value="not-yet-were-planning-on-applying-soon">Not yet, we're planning on applying soon</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Which trip components would you like me to plan?" description="Please Click All That Apply" name="which-trip-components-would-you-like-me-to-plan">&#13;
			<option label="Accommodations" value="accommodations">Accommodations</option>&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Tours and Activities" value="tours-and-activities">Tours and Activities</option>&#13;
			<option label="Transporation - transfers, car rental, trains, ferry, etc" value="transporation-transfers-car-rental-trains-ferry-etc">Transporation - transfers, car rental, trains, ferry, etc</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="I'm not sure (no worries, we can discuss as we plan)" value="im-not-sure-no-worries-we-can-discuss-as-we-plan">I'm not sure (no worries, we can discuss as we plan)</option>&#13;
		</field>&#13;
		<field type="text" label="Where would you like to go? (If you are unsure, I&#39;m happy to find you the perfect place!)" placeholder="ex: Hawaii  Italy  Greece  Jamaica  Mexico" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="text" label="When would you like to leave for your trip? If you have multiple dates or a range of dates, please list below." description="This can always be changed later." name="when-would-you-like-to-leave-for-your-trip-if-you-have-multiple-dates-or-a-range-of-dates-please-list-below" subtype="text" 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;
			<option label="No" value="no">No</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="How many room(s) will you need?" name="how-many-rooms-will-you-need" other="true">&#13;
			<option label="One Room " value="one-room-">One Room </option>&#13;
			<option label="One room (with TWO beds)" value="one-room-with-two-beds">One room (with TWO beds)</option>&#13;
			<option label="Two separate rooms" value="two-separate-rooms">Two separate rooms</option>&#13;
			<option label="Two Rooms (connecting)" value="two-rooms-connecting">Two Rooms (connecting)</option>&#13;
			<option label="We prefer suites with a bedroom(s) and a separate living room space" value="we-prefer-suites-with-a-bedrooms-and-a-separate-living-room-space">We prefer suites with a bedroom(s) and a separate living room space</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="I&#39;m interested in...." name="activity-preferences">&#13;
			<option label="An All-Inclusive Resort" value="an-allinclusive-resort">An All-Inclusive Resort</option>&#13;
			<option label="Hotels/Resorts (NOT All-Inclusive)" value="hotelsresorts-not-allinclusive">Hotels/Resorts (NOT All-Inclusive)</option>&#13;
			<option label="Multi-stop Itinerary (Visiting several cities, islands, or countries)" value="multistop-itinerary-visiting-several-cities-islands-or-countries">Multi-stop Itinerary (Visiting several cities, islands, or countries)</option>&#13;
			<option label="River Cruise (e.g. Europe, Asia)" value="river-cruise-eg-europe-asia">River Cruise (e.g. Europe, Asia)</option>&#13;
			<option label="Ocean Cruise (e.g. Caribbean, Alaska, Disney Cruise)" value="ocean-cruise-eg-caribbean-alaska-disney-cruise">Ocean Cruise (e.g. Caribbean, Alaska, Disney Cruise)</option>&#13;
			<option label="Land Escorted/Guided Tour with others (Collette, Adventures with Disney, Tauck)" value="land-escortedguided-tour-with-others-collette-adventures-with-disney-tauck">Land Escorted/Guided Tour with others (Collette, Adventures with Disney, Tauck)</option>&#13;
			<option label="I'm not sure (that's ok, we can discuss later)" value="im-not-sure-thats-ok-we-can-discuss-later">I'm not sure (that's ok, we can discuss later)</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Which of the following helps to describe your goals for this trip?" description="Check all that apply." name="vibe-preference">&#13;
			<option label="Adults-Only" value="adultsonly">Adults-Only</option>&#13;
			<option label="Family Friendly" value="family-friendly">Family Friendly</option>&#13;
			<option label="Multi-Generational" value="multigenerational">Multi-Generational</option>&#13;
			<option label="Off the Beaten Path" value="off-the-beaten-path">Off the Beaten Path</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Food and/or wine experience" value="food-andor-wine-experience">Food and/or wine experience</option>&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What is your budget for this trip? (NOT including airfare)" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$4,000 to $6,000" value="4000-to-6000">$4,000 to $6,000</option>&#13;
			<option label="$6,000 to $10,000" value="6000-to-10000">$6,000 to $10,000</option>&#13;
			<option label="$10,00 to $15,000" value="1000-to-15000">$10,00 to $15,000</option>&#13;
			<option label="$15,000 to $20,000" value="15000-to-20000">$15,000 to $20,000</option>&#13;
			<option label="$20,000 to $30,000" value="20000-to-30000">$20,000 to $30,000</option>&#13;
			<option label="$30,000-$50,000" value="3000050000">$30,000-$50,000</option>&#13;
			<option label="$50,000+" value="50000">$50,000+</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="text" label="Are you celebrating a special occasion?" name="are-you-celebrating-a-special-occasion" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Does anyone in your party have any dietary restrictions?" name="does-anyone-in-your-party-have-any-dietary-restrictions" className="form-control"/>&#13;
		<field type="text" label="Does anyone in your party have any mobility supports needed or pre-existing conditions I need to be aware of as we plan?" name="does-anyone-in-your-party-have-any-mobility-supports-needed-or-preexisting-conditions-i-need-to-be-aware-of-as-we-plan" subtype="text" 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;
	</fields>&#13;
</form-template>
  </body>
</html>