Share your information with Kristin Smith

Kristin Smith

The Hello Agency

<html>
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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="INQUIRY - AFRICA"/>&#13;
		<field type="header" subtype="h1" label="CLIENT INFORMATION"/>&#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 type="date" required="true" label="Your Date of Birth" name="your-date-of-birth" 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="textarea" label="Would you like to add anyone to our communications? Please list their name(s) and email(s) below.&amp;nbsp;" name="would-you-like-to-add-anyone-to-our-communications-please-list-their-names-and-emails-below-" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="ABOUT YOUR TRIP"/>&#13;
		<field type="textarea" required="true" label="What is the purpose for this vacation? Can you explain a little bit about what you&#39;re looking for?&amp;nbsp;" name="what-is-the-purpose-for-this-vacation-can-you-explain-a-little-bit-about-what-youre-look-for-" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Who all will be traveling with you? Please list all full names (including middle) AND birthdates, as listed on passport." name="who-all-will-be-traveling-with-you-please-list-all-full-names-including-middle-and-birthdates-as-listed-on-passport" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to depart?" name="when-would-you-like-to-depart" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" name="when-would-you-like-to-return" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are your dates flexible?" name="are-your-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="If flexible, please share a date range. *If sharing a range of dates, please list exact date ranges vs. general availability.&amp;nbsp;" name="if-flexible-please-share-a-date-range" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your intended length of the trip?&amp;nbsp;" name="what-is-your-intended-length-of-the-trip-" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Have you been to Africa and or a Safari before? If so, what destinations and lodges did you visit?&amp;nbsp;" name="have-you-been-to-africa-and-or-a-safari-before-if-so-what-destinations-and-lodges-did-you-visit-" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Which countries are you interested in visiting?&amp;nbsp;" name="which-countries-are-you-interested-in-visiting-" other="true">&#13;
			<option label="Botswana" value="botswana">Botswana</option>&#13;
			<option label="Namibia" value="namibia">Namibia</option>&#13;
			<option label="Kenya" value="kenya">Kenya</option>&#13;
			<option label="Rwanda" value="rwanda">Rwanda</option>&#13;
			<option label="Uganda" value="uganda">Uganda</option>&#13;
			<option label="Egypt " value="egypt-">Egypt </option>&#13;
			<option label="Malawi" value="malawi">Malawi</option>&#13;
			<option label="Mozambique" value="mozambique">Mozambique</option>&#13;
			<option label="Seychelles" value="seychelles">Seychelles</option>&#13;
		</field>&#13;
		<field type="text" label="Are there any destinations that you want to avoid?" name="are-there-any-destinations-that-you-want-to-avoid" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What is your estimated investment per traveler (excluding flights and optional travel insurance)?" description="(on average Africa itineraries start at 10k per person)" name="what-is-your-estimated-investment-for-all-travelers-including-accommodations-and-activities-like-tours-and-transportation-excluding-flights-meals-and-optional-travel-insurance">&#13;
			<option label="Whatever it takes to create the experience I am looking for" value="whatever-it-takes-to-create-the-experience-i-am-looking-for">Whatever it takes to create the experience I am looking for</option>&#13;
			<option label="$20,000+" value="20000">$20,000+</option>&#13;
			<option label="$15,000-$20,000" value="1500020000">$15,000-$20,000</option>&#13;
			<option label="$10,000 - $15,000" value="10000-15000">$10,000 - $15,000</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Which of the following is important to you (check all that apply)?" name="which-of-the-following-is-important-to-you-check-all-that-apply" other="true">&#13;
			<option label="Authentic/Local Accommodations" value="authenticlocal-accommodations">Authentic/Local Accommodations</option>&#13;
			<option label="Luxury Resorts/Camps " value="luxury-resortscamps-">Luxury Resorts/Camps </option>&#13;
			<option label="AC/Charging Power in Room Required" value="accharging-power-in-room-required">AC/Charging Power in Room Required</option>&#13;
			<option label="Handicap Accessible " value="handicap-accessible-">Handicap Accessible </option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Please list all that are of interest during this trip?&amp;nbsp;" name="which-best-describes-your-priorities-for-this-trip-select-multiple" other="true">&#13;
			<option label="Safari/Game Drives" value="safarigame-drives">Safari/Game Drives</option>&#13;
			<option label="Gorilla Trekking" value="gorilla-trekking">Gorilla Trekking</option>&#13;
			<option label="Photography" value="photography">Photography</option>&#13;
			<option label="Cooking Classes" value="cooking-classes">Cooking Classes</option>&#13;
			<option label="Beach " value="beach-">Beach </option>&#13;
			<option label="History" value="history">History</option>&#13;
			<option label="Culture" value="culture">Culture</option>&#13;
			<option label="Shopping" value="shopping">Shopping</option>&#13;
			<option label="Hot Air Balloon " value="hot-air-balloon-">Hot Air Balloon </option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Room Type Preference:&amp;nbsp;" name="room-bedding-preferences-check-all-that-apply" other="true">&#13;
			<option label="King Preferred " value="king-preferred-">King Preferred </option>&#13;
			<option label="2 Queens (or 2 beds) Preferred" value="2-queens-or-2-beds-preferred">2 Queens (or 2 beds) Preferred</option>&#13;
			<option label="Suite (Bed and Den Space separated by a door)" value="suite-bed-and-den-space-separated-by-a-door">Suite (Bed and Den Space separated by a door)</option>&#13;
			<option label="Villa/Condo/House (Multiple Bedrooms and Living Space)" value="villacondohouse-multiple-bedrooms-and-living-space">Villa/Condo/House (Multiple Bedrooms and Living Space)</option>&#13;
			<option label="Connecting Rooms " value="connecting-rooms-">Connecting Rooms </option>&#13;
			<option label="Luxury Tent" value="luxury-tent">Luxury Tent</option>&#13;
			<option label="I Am Okay With Roughing It" value="i-am-okay-with-roughing-it">I Am Okay With Roughing It</option>&#13;
		</field>&#13;
		<field type="radio-group" label="If applicable, is it a deal breaker if rooms do not connect?&amp;nbsp;" name="if-applicable-is-it-a-deal-breaker-if-rooms-do-not-connect-">&#13;
			<option label="Yes " value="yes-">Yes </option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Is everyone a US citizen, with a passport valid for at least 6 months after your return?&amp;nbsp;" name="is-everyone-a-us-citizen-with-a-passport-valid-for-at-least-6-months-after-your-return-" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Final Notes To Further Customize Your Travel"/>&#13;
		<field type="radio-group" required="true" label="Are you interested in adding our Concierge Services for detailed itinerary planning to include dining reservations, spa, and recreational bookings?*&amp;nbsp;" name="are-you-interested-in-adding-our-concierge-services-for-detailed-itinerary-planning-to-include-dining-reservations-spa-and-recreational-bookings-">&#13;
			<option label="Yes, I am interested" value="yes-i-am-interested">Yes, I am interested</option>&#13;
			<option label="No, I will book these myself" value="no-i-will-book-these-myself">No, I will book these myself</option>&#13;
			<option label="Unsure, can we talk about this more?" value="unsure-can-we-talk-about-this-more">Unsure, can we talk about this more?</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="I understand Professional Planning Fees are associated based on the level of services required. Please note, that we have a Fee Structure for our professional planning services. These fees vary based on the type of trip and level of service required. This will be discussed on your complimentary planning call with your agent." name="i-understand-professional-planning-fees-are-associated-based-on-the-level-of-services-required-please-note-that-we-have-a-fee-structure-for-our-professional-planning-services-these-fees-vary-based-on-the-type-of-trip-and-level-of-service-required-this-will-be-discussed-on-your-complimentary-planning-call-with-your-agent">&#13;
			<option label="Yes, I understand" value="yes-i-understand">Yes, I understand</option>&#13;
			<option label="I'm confused, please explain further" value="im-confused-please-explain-further">I'm confused, please explain further</option>&#13;
		</field>&#13;
		<field type="textarea" label="Any other notes on your preferences or dreams for this trip to help me tailor it for you?" name="any-other-notes-on-your-preferences-or-dreams-for-this-trip-to-help-me-tailor-it-for-you" className="form-control"/>&#13;
	</fields>&#13;
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