Share your information with Kami Hagel

Kami Hagel

Good Land Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="text" required="true" label="First Name" name="first-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" 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="checkbox-group" required="true" label="What is your travel status?" name="what-is-your-travel-status">&#13;
			<option label="I am thinking about going on a trip" value="i-am-thinking-about-going-on-a-trip">I am thinking about going on a trip</option>&#13;
			<option label="I am at the beginning stages of planning a trip" value="i-am-at-the-beginning-stages-of-planning-a-trip">I am at the beginning stages of planning a trip</option>&#13;
			<option label="I am shopping around with various agencies for pricing" value="i-am-shopping-around-with-various-agencies-for-pricing">I am shopping around with various agencies for pricing</option>&#13;
			<option label="I am ready to travel if the trip budget is right" value="i-am-ready-to-travel-if-the-trip-budget-is-right">I am ready to travel if the trip budget is right</option>&#13;
			<option label="I am ready to travel and get my trip booked" value="i-am-ready-to-travel-and-get-my-trip-booked">I am ready to travel and get my trip booked</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What destinations are you interested in traveling to?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Are your dates flexible?" inline="true" name="dates-flexible">&#13;
			<option label="Yes" value="">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="If yes, please provide more detail" name="if-yes-please-provide-more-detail" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Do you require flights?" name="do-you-require-flights">&#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 travelers?" name="how-many-travelers" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Are you traveling with children? (Individuals under the age of 18)" description="Individuals under the age of 18" name="are-you-traveling-with-children">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="If yes, please list their ages at the time of travel" name="if-yes-please-list-their-ages" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Are you traveling with a group?" name="are-you-traveling-with-a-group" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your total budget for this trip including all travelers?" name="what-is-your-total-budget-for-this-trip-including-all-travelers" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Would you like travel insurance included in your quote?" name="would-you-like-travel-insurance-included-in-your-quote">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What best describes your hotel preference?" name="what-best-describes-your-hotel-preference">&#13;
			<option label="Economy" value="economy">Economy</option>&#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="All-Inclusive" value="allinclusive">All-Inclusive</option>&#13;
			<option label="Adults Only" value="adults-only">Adults Only</option>&#13;
			<option label="Kid-Friendly" value="kidfriendly">Kid-Friendly</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have a specific hotel or hotel chain you are interested in?" name="do-you-have-a-specific-hotel-or-hotel-chain-you-are-interested-in" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#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-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach " value="beach-">Beach </option>&#13;
			<option label="Pool" value="">Pool</option>&#13;
			<option label="Water park" value="water-park">Water park</option>&#13;
			<option label="Kids activities" value="kids-activities">Kids activities</option>&#13;
			<option label="Casino" value="casino">Casino</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Local sightseeing tours" value="local-sightseeing-tours">Local sightseeing tours</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="checkbox-group" label="How did you find&amp;nbsp; us?" name="how-did-you-find-us">&#13;
			<option label="Internet" value="internet">Internet</option>&#13;
			<option label="Referral " value="referral-">Referral </option>&#13;
			<option label="The Planning Mom" value="the-planning-mom">The Planning Mom</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" label="If you chose referral or other, please explain." name="if-you-chose-referral-or-other-please-explain" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>