<form-template>
	<fields>
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>
		<field type="paragraph" subtype="p" label="DETAILS ABOUT YOUR TRIP"/>
		<field type="text" required="true" label="What countries or regions are you interested in visiting?" description="&quot;No idea&#x201D; is okay!" placeholder="&quot;No idea&#x201D; is okay!" name="destination" subtype="text" className="form-control"/>
		<field type="text" required="true" label="When do you wish to travel?" placeholder="Approximate or exact dates" name="when-do-you-wish-to-travel" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Are you traveling alone or with others? If with others, how many?" name="how-many-travelers" subtype="text" className="form-control"/>
		<field type="radio-group" required="true" label="What is your budget for this custom journey? (Excluding airfare)" name="what-is-your-budget-for-this-custom-journey">
			<option label="$500 or less per person, per day" value="500-or-less-per-person-per-day">$500 or less per person, per day</option>
			<option label="$501 - $1000 per person, per day" value="501-1000-per-person-per-day">$501 - $1000 per person, per day</option>
			<option label="$1001 - $1500 per person, per day" value="1001-1500-per-person-per-day">$1001 - $1500 per person, per day</option>
			<option label="$1501 - $2000 per person, per day" value="1501-2000-per-person-per-day">$1501 - $2000 per person, per day</option>
			<option label="$5000 per person, per day" value="5000-per-person-per-day">$5000 per person, per day</option>
		</field>
		<field type="radio-group" label="What kind of travel design do you need?" name="what-kind-of-travel-design-do-you-need">
			<option label="A dream trip" value="a-dream-trip">A dream trip</option>
			<option label="Guidance to outline travel" value="guidance-to-outline-travel">Guidance to outline travel</option>
			<option label="Help with a specific element of travel" value="help-with-a-specific-element-of-travel">Help with a specific element of travel</option>
			<option label="Destination booking with VIP upgrades and amenities (resort, activities, restaurants, etc)" value="destination-booking-with-vip-upgrades-and-amenities-resort-activities-restaurants-etc">Destination booking with VIP upgrades and amenities (resort, activities, restaurants, etc)</option>
		</field>
		<field type="paragraph" subtype="p" label="DETAILS ABOUT YOU"/>
		<field type="checkbox-group" label="Which best describes you regarding this trip?" name="which-best-describes-you-regarding-this-trip" other="true">
			<option label="Pleasure-seeker interested in maintaining health while traveling" value="pleasureseeker-interested-in-maintaining-health-while-traveling">Pleasure-seeker interested in maintaining health while traveling</option>
			<option label="Tired folk in need of a retreat to focus on wellbeing" value="tired-folk-in-need-of-a-retreat-to-focus-on-wellbeing">Tired folk in need of a retreat to focus on wellbeing</option>
			<option label="Busy business traveler looking for someone to take care of the details" value="busy-business-traveler-looking-for-someone-to-take-care-of-the-details">Busy business traveler looking for someone to take care of the details</option>
			<option label="Holiday seeker marking a life passage (birthday, honeymoon, retirement)" value="holiday-seeker-marking-a-life-passage-birthday-honeymoon-retirement">Holiday seeker marking a life passage (birthday, honeymoon, retirement)</option>
			<option label="Mourner in need of serious TLC (loss of job, death of a loved one, end of marriage)" value="mourner-in-need-of-serious-tlc-loss-of-job-death-of-a-loved-one-end-of-marriage">Mourner in need of serious TLC (loss of job, death of a loved one, end of marriage)</option>
			<option label="Overwhelmed workaholic in need of a talented escape artist to feel human again" value="overwhelmed-workaholic-in-need-of-a-talented-escape-artist-to-feel-human-again">Overwhelmed workaholic in need of a talented escape artist to feel human again</option>
			<option label="Wellness professional interested in creating a retreat for clients" value="wellness-professional-interested-in-creating-a-retreat-for-clients">Wellness professional interested in creating a retreat for clients</option>
		</field>
		<field type="checkbox-group" label="Where are you in the planning process?" name="where-are-you-in-the-planning-process" other="true">
			<option label="I'm a blank slate, ready for inspiration" value="im-a-blank-slate-ready-for-inspiration">I'm a blank slate, ready for inspiration</option>
			<option label="I've got some ideas, but need help" value="ive-got-some-ideas-but-need-help">I've got some ideas, but need help</option>
			<option label="I more or less know what I want, but need help finalizing the details" value="i-more-or-less-know-what-i-want-but-need-help-finalizing-the-details">I more or less know what I want, but need help finalizing the details</option>
		</field>
		<field type="text" required="true" label="What country is your passport issued from?" name="what-country-is-your-passport-issued-from" subtype="text" className="form-control"/>
		<field type="paragraph" subtype="p" label="LAST DETAILS"/>
		<field type="textarea" label="Tell me more about your travel dreams:" name="tell-me-more-about-your-travel-dreams" className="form-control"/>
		<field type="radio-group" required="true" label="Would you like to receive The PWT Index, Premier Wellness Travel's newsletter?" name="last-details">
			<option label="I'd love to get the PWT Index!" value="id-love-to-get-the-pwt-index">I'd love to get the PWT Index!</option>
			<option label="No, thank you" value="no-thank-you">No, thank you</option>
		</field>
		<field type="checkbox-group" label="How did you hear about Premier Wellness Travel?" name="how-did-you-hear-about-premier-wellness-travel" other="true">
			<option label="Facebook" value="facebook">Facebook</option>
			<option label="Instagram" value="instagram">Instagram</option>
			<option label="Pinterest" value="pinterest">Pinterest</option>
			<option label="LinkedIn" value="linkedin">LinkedIn</option>
			<option label="Eventbrite" value="eventbrite">Eventbrite</option>
			<option label="YouTube" value="youtube">YouTube</option>
			<option label="Friend" value="friend">Friend</option>
			<option label="Internet Search" value="internet-search">Internet Search</option>
		</field>
		<field type="checkbox-group" required="true" label="I understand that Premier Wellness Travel charges a planning fee for most services." name="i-am-aware-that-premier-wellness-travel-charges-a-planning-fee-for-most-services-and-have-read-and-reviewed-the-service-page">
			<option label="Yes" value="yes">Yes</option>
		</field>
	</fields>
</form-template>