Laurie Johnson

Pura Vida Vacations

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    <form-template>&#13;
	<fields>&#13;
		<field type="paragraph" subtype="p" label="Thank you for completing this questionnaire! Your responses give us the essential information we need to start planning your cruise vacation. The more details you provide, the better we can customize your experience, match you with the right cruise line, and create an itinerary tailored to your preferences. Please note that a planning fee applies, and we do not book trips using points or miles."/>&#13;
		<field type="header" subtype="h1" label="Traveler 1 (as written on passport)"/>&#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="date" required="true" label="Date of birth" name="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="Best Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="&amp;nbsp;Do all travelers have Passports valid for 6 months after your travel return date?" name="-do-all-travelers-have-passports-valid-for-6-months-after-your-travel-return-date" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Working on it" value="working-on-it">Working on it</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Are there any special needs, diets, health concerns we should be aware of?" name="any-special-needs-dietary-preferences-or-medical-considerations-we-should-be-aware-of" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Desired Travel Dates"/>&#13;
		<field type="date" required="true" label="Departure Date" name="departure-date" className="form-control"/>&#13;
		<field type="date" required="true" label="Return Date" name="return-date" className="form-control"/>&#13;
		<field type="radio-group" 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" required="true" label="How many adults will be traveling?" name="how-many-adults-will-be-traveling" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many children will be traveling?&amp;nbsp; If any, please provide ages." name="how-many-children-will-be-traveling-if-any-please-provide-ages" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Trip Length Preference" name="trip-length-preference">&#13;
			<option label="1-7 days" value="17-days">1-7 days</option>&#13;
			<option label="8-14 days" value="814-days">8-14 days</option>&#13;
			<option label="15-21 days" value="1521-days">15-21 days</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="What research have you done? Is there anything you absolutely must do or see?" name="what-research-have-you-done-is-there-anything-you-absolutely-must-do-or-see" className="form-control"/>&#13;
		<field type="text" label="Please list your preferred Cruise port city for embarkation, if applicable" name="please-list-your-preferred-cruise-port-city-for-embarkation-if-applicable" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="What type of cruise do you prefer?" name="travel-details" multiple="multiple" className="form-control">&#13;
			<option label="Luxury Ocean Cruise" value="luxury-ocean-cruise">Luxury Ocean Cruise</option>&#13;
			<option label="River Cruise" value="river-cruise">River Cruise</option>&#13;
			<option label="Expedition Cruise" value="expedition-cruise">Expedition Cruise</option>&#13;
			<option label="Yacht Experience" value="yacht-experience">Yacht Experience</option>&#13;
		</field>&#13;
		<field type="select" label="Cruise Destination Interests" name="cruise-destination-interests" multiple="multiple" className="form-control">&#13;
			<option label="Mediterranean" value="mediterranean">Mediterranean</option>&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="Asia" value="asia">Asia</option>&#13;
			<option label="South Pacific" value="south-pacific">South Pacific</option>&#13;
			<option label="Africa" value="africa">Africa</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many cabins?" name="how-many-cabins" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What type of cabin(s) are you interested in?" name="preferred-cabin-category">&#13;
			<option label="Interior Cabin" value="interior-cabin">Interior Cabin</option>&#13;
			<option label="Outside Cabin" value="outside-cabin">Outside Cabin</option>&#13;
			<option label="Balcony Cabin" value="balcony-cabin">Balcony Cabin</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Concierge Level" value="concierge-level">Concierge Level</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What type of cruise experience(s) are you looking for?" name="what-type-of-cruise-experiences-are-you-looking-for" multiple="multiple" className="form-control">&#13;
			<option label="Relaxation &amp; Leisure Focused" value="relaxation-leisure-focused">Relaxation &amp; Leisure Focused</option>&#13;
			<option label="Cultural Exploration" value="cultural-exploration">Cultural Exploration</option>&#13;
			<option label="Historical &amp; Sightseeing" value="historical-sightseeing">Historical &amp; Sightseeing</option>&#13;
			<option label="Gourmet Culinary" value="gourmet-culinary">Gourmet Culinary</option>&#13;
			<option label="Nature &amp; Wildlife Adventure" value="nature-wildlife-adventure">Nature &amp; Wildlife Adventure</option>&#13;
			<option label="Wellness &amp; Spa Focused" value="wellness-spa-focused">Wellness &amp; Spa Focused</option>&#13;
			<option label="Enrichment Programs &amp; Lectures" value="enrichment-programs-lectures">Enrichment Programs &amp; Lectures</option>&#13;
			<option label="Beach or Coastal Relaxation" value="beach-or-coastal-relaxation">Beach or Coastal Relaxation</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Additional Services"/>&#13;
		<field type="radio-group" label="Would you like assistance with any of the following?" name="would-you-like-assistance-with-any-of-the-following" other="true">&#13;
			<option label="Pre or post cruise hotel stays" value="pre-or-post-cruise-hotel-stays">Pre or post cruise hotel stays</option>&#13;
			<option label="Pre or post cruise extensions" value="pre-or-post-cruise-extensions">Pre or post cruise extensions</option>&#13;
			<option label="Private transfers" value="private-transfers">Private transfers</option>&#13;
			<option label="Travel Insurance" value="travel-insurance">Travel Insurance</option>&#13;
			<option label="Group Travel Coordination" value="group-travel-coordination">Group Travel Coordination</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Budget"/>&#13;
		<field type="checkbox-group" required="true" label="What is your budget for this cruise, not including flights? (per person)" name="what-is-your-approximate-budget-per-travelers-for-this-experience-excluding-airfare" other="true">&#13;
			<option label="$8,000 - $10,000" value="8000-10000">$8,000 - $10,000</option>&#13;
			<option label="$10,000-$15,000" value="1000015000">$10,000-$15,000</option>&#13;
			<option label="$15,000 - $20,000" value="15000-20000">$15,000 - $20,000</option>&#13;
			<option label="$20,000 - $25,000" value="20000-25000">$20,000 - $25,000</option>&#13;
			<option label="$25,000 - $30,000" value="25000-30000">$25,000 - $30,000</option>&#13;
			<option label="$30,000 +" value="30000-">$30,000 +</option>&#13;
		</field>&#13;
		<field type="textarea" label="Do you need an air quote?&amp;nbsp; If so, please provide your home airport, plus what class of service you prefer." name="do-you-need-an-air-quote-if-so-please-provide-your-home-airport-plus-what-class-of-service-you-prefer" className="form-control"/>&#13;
		<field type="textarea" label="Is there anything else you would like to share with us?" name="is-there-anything-else-you-would-like-to-share-with-us" className="form-control"/>&#13;
		<field type="text" label="How did you find us?" description="i.e. Google search  social media  Personal Referral  etc." name="how-did-you-find-us" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
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