Share your information with Kelli Nordin

Kelli Nordin

Let Your Mind Unwind

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		<field type="header" subtype="h1" label="Let Your Mind Unwind New Client Information"/>&#13;
		<field type="header" subtype="h2" label="Travelers Basic 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="text" required="true" label="How many travelers? (Include ages if children)" name="how-many-travelers-include-ages-if-children" 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="header" subtype="h2" label="Address"/>&#13;
		<field type="text" 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" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Questions for your trip&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Where would you like to travel??" description="If you are not sure just give me a few destinations you are considering." placeholder="Tahiti" name="where-would-you-like-to-travel" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your departure city?" description="Where will you be flying from?" name="what-is-your-departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="When would you like to depart?" description="This just gives me a general idea of when you would like to go. This can be changed later." name="when-would-you-like-to-depart" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="When would you like to return?" description="This just gives me a general idea of when you would like to return. This can be changed later." name="when-would-you-like-to-return" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?&amp;nbsp;" name="are-your-dates-flexible-" other="true">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="How many days total are you looking to travel? (from take off to arrival back home)" name="how-many-days-total-are-you-looking-to-travel-from-take-off-to-arrival-back-home" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="What is your budget for all travelers (excluding flights)??&amp;nbsp;" description="This just gives me a general starting point and can always be changed later." name="what-is-your-budget-for-all-travelers-excluding-flights-">&#13;
			<option label="$1,500 to $4,500 (only for weekend trips 5 or less days)" value="1500-to-4500-only-for-weekend-trips-5-or-less-days">$1,500 to $4,500 (only for weekend trips 5 or less days)</option>&#13;
			<option label="$4,500 to $6,500" value="4500-to-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-to-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-to-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000 to $15,000" value="10000-to-15000">$10,000 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+" value="20000">$20,000+</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What is your budget per night at hotels?" name="what-is-your-budget-per-night-at-hotels">&#13;
			<option label="$400-$500" value="400500">$400-$500</option>&#13;
			<option label="$500-$650" value="500650">$500-$650</option>&#13;
			<option label="$650-$800" value="650800">$650-$800</option>&#13;
			<option label="$800-$950" value="800950">$800-$950</option>&#13;
			<option label="$950-$1200" value="9501200">$950-$1200</option>&#13;
			<option label="$1200-$1500" value="12001500">$1200-$1500</option>&#13;
			<option label="$1500-$2000" value="15002000">$1500-$2000</option>&#13;
			<option label="$2000-$3000" value="20003000">$2000-$3000</option>&#13;
			<option label="$3000+" value="3000">$3000+</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What best describes your hotel/accommodation preference?" name="what-best-describes-your-hotelaccommodation-preference">&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Ultra Luxury" value="ultra-luxury">Ultra Luxury</option>&#13;
			<option label="Luxury Villa (Group, Multi-Generational Travel)" value="luxury-villa-group-multigenerational-travel">Luxury Villa (Group, Multi-Generational Travel)</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Do you plan on using rewards/cc points for any part of this booking except flights? **Please note, for any days Let Your Mind Unwind is planning travel hotels must be booked directly through the advisor. There are some situations where stand alone planning can be accommodated, but will in most cases incur an additional cost. **If planning to use points please provide additional detail. *?" description="CC means Credit Card" name="do-you-plan-on-using-rewardscc-points-for-any-part-of-this-booking-except-flights-please-note-for-any-days-let-your-mind-unwind-is-planning-travel-hotels-must-be-booked-directly-through-the-advisor-there-are-some-situations-where-stand-alone-planning-can-be-accommodated-but-will-in-most-cases-incur-an-additional-cost-if-planning-to-use-points-please-provide-additional-detail-">&#13;
			<option label="Yes, all hotels " value="yes-all-hotels-">Yes, all hotels </option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="For some hotels" value="for-some-hotels">For some hotels</option>&#13;
			<option label="Not Sure" value="not-sure">Not Sure</option>&#13;
			<option label="Flights Only" value="flights-only">Flights Only</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply" name="what-kind-of-vibe-are-you-looking-for">&#13;
			<option label="Romantic " value="romantic-">Romantic </option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path " value="off-the-beaten-path-">Off the beaten path </option>&#13;
			<option label="Party " value="party-">Party </option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly " value="family-friendly-">Family friendly </option>&#13;
			<option label="Food and wine " value="food-and-wine-">Food and wine </option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What hotels have you stayed in before that you have loved?&amp;nbsp;" name="what-hotels-have-you-stayed-in-before-that-you-have-loved-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Tell me about your hopes/dreams for your trip! Anything you absolutely must do or see? Or anything else you want me to know?" description="What else would you like me to know about your travelers budget or preferences?" name="tell-me-about-your-hopesdreams-for-your-trip-anything-you-absolutely-must-do-or-see-or-anything-else-you-want-me-to-know" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Let Your Mind Unwind Client Agreement&amp;nbsp;"/>&#13;
		<field type="paragraph" subtype="p" label="When you retain Let Your Mind Unwind, LLC to help plan your travel, you&#39;re hiring a professional travel advisor to ensure that your trip is tailored to your taste, preferences, and budget. You get the benefit of our skill, experience, and training, our professional relationships, and our industry connections. Our Professional Services Fee covers your consultation, our research and recommendations, preparation of quotes and itineraries, reserving and booking each element of your trip, securing quotes for comprehensive travel insurance, administration of your booking from deposit to departure, and follow-up post-trip with suppliers (as needed). By checking the box below and submitting this form, you acknowledge that you are hiring us to plan your trip and that you have read and agree to our Terms and Conditions of booking, which are located at: https://docs.google.com/document/d/13c61ZkTEFa1Dg1_7-yQ5le_VF54ZPh80TDjCQ709FYU/edit"/>&#13;
		<field type="checkbox-group" required="true" label="Client Agreement&amp;nbsp;" name="client-agreement-">&#13;
			<option label="I Agree" value="i-agree">I Agree</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Travel Insurance Acknowledgement"/>&#13;
		<field type="paragraph" subtype="p" label="Emergencies can happen when you least expect them. Let Your Mind Unwind, LLC highly recommends that all clients purchase a travel insurance policy to protect their investment in their travel. Cruise lines, airlines, hotels, and tour operators all charge high penalties for cancellation, ranging from the full deposit to no refund at all. And, keep in mind that most health insurance policies will not cover you when you are out of the country. Travel insurance can protect you in the event of Trip Cancellation, Trip Delay, Trip Interruption, Missed Connection, Baggage Loss, Theft or Damage, Baggage Delay, Emergency Medical and Dental Expenses, and Emergency Medical Transportation, among other unforeseen circumstances. Please also note that in order for you to obtain coverage for certain pre-existing conditions, or for supplier default, your policy must be purchased at the time of booking or shortly thereafter(depending on the terms of the policy). Please understand that we are not registered insurance agents and cannot legally provide specific advice or information regarding insurance. We will gladly secure a quote for you, upon request, and if Let Your Mind Unwind, LLC does not, or is not legally able to secure coverage on your behalf, it is our strong recommendation that you purchase a policy on your own.I acknowledge that Let Your Mind Unwind, LLC has recommended or offered travel insurance protection to me. Should I choose not to purchase such a policy, I accept all responsibility for declining to secure coverage.&amp;nbsp;"/>&#13;
		<field type="checkbox-group" required="true" label="Travel Insurance Acknowledgement" name="travel-insurance-acknowledgement">&#13;
			<option label="I Agree" value="i-agree">I Agree</option>&#13;
		</field>&#13;
		<field type="text" label="Text Field" name="text-1776120026401" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
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