Share your information with Breeah M

Breeah M

The Nomadic Compass

<html>
  <body>
    <form-template>&#13;
	<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="h2" label="ROOMMATE PREFERENCES"/>&#13;
		<field type="text" label="Which Trip Do You Need a Roommate For?" name="which-trip-do-you-need-a-roommate-for" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Basics &amp;amp; Lifestyle"/>&#13;
		<field type="radio-group" label="Age Range" name="radio-group-1770343692565">&#13;
			<option label="20 - 30 years old" value="20-30-years-old">20 - 30 years old</option>&#13;
			<option label="30 - 40 years old" value="30-40-years-old">30 - 40 years old</option>&#13;
			<option label="40 - 50 years old" value="40-50-years-old">40 - 50 years old</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Typical Schedule" name="radio-group-1770343829448">&#13;
			<option label="Early Bird" value="early-bird">Early Bird</option>&#13;
			<option label="Night Owl" value="night-owl">Night Owl</option>&#13;
			<option label="Mix of Both" value="mix-of-both">Mix of Both</option>&#13;
		</field>&#13;
		<field type="select" label="How often are you in your hotel room?" name="select-1770343874676" className="form-control">&#13;
			<option label="Any time there's free time" value="any-time-theres-free-time">Any time there's free time</option>&#13;
			<option label="Rarely, I'm out all day and night" value="rarely-im-out-all-day-and-night">Rarely, I'm out all day and night</option>&#13;
			<option label="Occasionally, I'll come back through out the day " value="occasionally-ill-come-back-through-out-the-day-">Occasionally, I'll come back through out the day </option>&#13;
		</field>&#13;
		<field type="radio-group" label="What is your typical level of alcohol consumption while on vacation?" name="what-is-your-typical-level-of-alcohol-consumption-while-on-vacation">&#13;
			<option label="Often" value="often">Often</option>&#13;
			<option label="Occasionally" value="occasionally">Occasionally</option>&#13;
			<option label="Rarely" value="rarely">Rarely</option>&#13;
			<option label="Never" value="never">Never</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Do you smoke cigarettes?" description="The smell may not bother some but may bother others" name="do-you-smoke-cigarettes">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="I don't smoke, but also don't mind rooming with someone who does" value="i-dont-smoke-but-also-dont-mind-rooming-with-someone-who-does">I don't smoke, but also don't mind rooming with someone who does</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Cleanliness &amp;amp; Organization"/>&#13;
		<field type="radio-group" label="How clean do you like shared spaces?" name="radio-group-1770343995278">&#13;
			<option label="Very Tidy" value="very-tidy">Very Tidy</option>&#13;
			<option label="Moderately Tidy" value="moderately-tidy">Moderately Tidy</option>&#13;
			<option label="Relaxed" value="relaxed">Relaxed</option>&#13;
		</field>&#13;
		<field type="text" label="How often should common areas be cleaned?" name="text-1770344088687" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What is your biggest cleanliness pet peeve?" name="text-1770344134154" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Noise Levels &amp;amp; Social Styles"/>&#13;
		<field type="radio-group" label="Are you sensitive to light//noise while sleeping?" name="are-you-sensitive-to-lightnoise-while-sleeping">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Do you typically use alarms or wake-up calls?" name="do-you-typically-use-alarms-or-wakeup-calls">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Typical noise level in your home" description="Includes noises from you and anything in your home environment" name="radio-group-1770344173488">&#13;
			<option label="Quiet" value="quiet">Quiet</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Lively" value="lively">Lively</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Do you like to listen to music or watch TV at a louder volume?" name="radio-group-1770344278368">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" label="On a scale of 1-10, how social are you?" description="10 being a social butterfly" name="on-a-scale-of-110-how-social-are-you" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
			<option label="8" value="8">8</option>&#13;
			<option label="9" value="9">9</option>&#13;
			<option label="10" value="10">10</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Sharing Items &amp;amp; Boundaries"/>&#13;
		<field type="radio-group" label="Are you comfortable sharing things in common spaces like food, toiletries, etc.?" name="radio-group-1770344470284">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Communication &amp;amp; Conflict Style"/>&#13;
		<field type="checkbox-group" label="How do you prefer to address issues/conflict?" name="checkbox-group-1770344540448">&#13;
			<option label="Talk it out immediately" value="talk-it-out-immediately">Talk it out immediately</option>&#13;
			<option label="Set up a time to talk later" value="set-up-a-time-to-talk-later">Set up a time to talk later</option>&#13;
		</field>&#13;
		<field type="textarea" label="List 3 things you must have in a roommate" name="textarea-1770345268392" className="form-control"/>&#13;
		<field type="textarea" label="List 3 deal-breakers in having a roommate" name="textarea-1770345325144" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>