Share your information with Rachelle Adams

Rachelle Adams

Rachelle Adams - Luxury Travel Consultant

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#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="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" 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="Preferred airport(s)" name="preferred-airports" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Do you have any dietary restrictions or food allergies?" name="text-1676148124799" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Do you have any medical conditions, disabilities, or physical limitations we should be aware of to ensure your comfort and safety during travel?" name="text-1676148116167" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Info"/>&#13;
		<field type="file" label="Photo of passport ID page" name="passport_photo" subtype="file" className="form-control"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
			<option label="X" value="other">X</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="radio-group" label="Hotel preference" name="hotel-preference" other="true">&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
			<option label="Resort" value="resort">Resort</option>&#13;
			<option label="Traditional Grand Hotel" value="traditional-grand-hotel">Traditional Grand Hotel</option>&#13;
			<option label="Design Hotel" value="design-hotel">Design Hotel</option>&#13;
			<option label="International Chain" value="international-chain">International Chain</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
			<option label="Twins" value="twins">Twins</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Flight - Seat preference (your preference/travel partner)" name="seat-preference">&#13;
			<option label="Aisle/Aisle" value="aisleaisle">Aisle/Aisle</option>&#13;
			<option label="Aisle/Middle" value="aislemiddle">Aisle/Middle</option>&#13;
			<option label="Window/Middle" value="windowmiddle">Window/Middle</option>&#13;
			<option label="Window/Window" value="windowwindow">Window/Window</option>&#13;
		</field>&#13;
		<field type="text" label="Inflight Meal preference" name="meal-preference" subtype="text" className="form-control"/>&#13;
		<field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/>&#13;
		<field type="text" label="Do you have Global Entry/Known Traveler Number? If so, please list" name="do-you-have-global-entryknown-traveler-number-if-so-please-list" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" label="Wedding anniversary" name="wedding-anniversary" className="form-control"/>&#13;
		<field type="text" label="Anything else you think we should know? (Special requests, traveling with a group, comments, notes, etc.):" name="text-1676148031733" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Please tell us about your favorite trips, best hotels, and most memorable adventure:" name="textarea-1676147783727" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Emergency Contact Information"/>&#13;
		<field type="textarea" required="true" label="Emergency Contact Information (Name/Relationship/Phone number)" name="emergency-contact-information" rows="3" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>