<form-template>
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>
		<field type="header" subtype="h1" label="Let's get started!"/>
		<field type="text" required="true" label="How were you referred to us?" description="So we can get you to the right agent" name="how-were-you-referred-to-us" subtype="text" className="form-control"/>
		<field type="checkbox-group" label="What is your preferred method of communication?" name="what-is-your-preferred-method-of-communication">
			<option label="Email" value="email">Email</option>
			<option label="Phone" value="phone">Phone</option>
			<option label="Text" value="text">Text</option>
		</field>
		<field type="checkbox-group" label="Would you like to schedule a phone consultation or would you like me to get started as soon as I receive the form?" name="would-you-like-to-schedule-a-phone-consultation-or-would-you-like-me-to-get-started-as-soon-as-i-receive-the-form">
			<option label="Phone consultation." value="phone-consultation">Phone consultation.</option>
			<option label="Get started!" value="get-started">Get started!</option>
		</field>
		<field type="text" label="Phone number (if you would like a phone consultation)" name="phone-number-if-you-would-like-a-phone-consultation" subtype="text" className="form-control"/>
		<field type="header" subtype="h2" label="Questions for your trip"/>
		<field type="checkbox-group" label="Where are you in the planning process?" name="where-are-you-in-the-planning-process" other="true">
			<option label="Just getting started." value="just-getting-started">Just getting started.</option>
			<option label="I have some ideas, but need help with research and planning." value="i-have-some-ideas-but-need-help-with-research-and-planning">I have some ideas, but need help with research and planning.</option>
			<option label="I know just what I want, but need help finalizing the details." value="i-know-just-what-i-want-but-need-help-finalizing-the-details">I know just what I want, but need help finalizing the details.</option>
		</field>
		<field type="text" label="Is the purpose of this trip to celebrate an occasion?" name="is-the-purpose-of-this-trip-to-celebrate-an-occasion" subtype="text" className="form-control"/>
		<field type="text" label="Preferred destinations?" description="If you're not sure  just give me a few destinations you're considering." placeholder="ex: Tahiti" name="preferred-destinations" subtype="text" className="form-control"/>
		<field type="radio-group" label="Vaccination Status (We only ask to know what destination to advise. All information is private)" description="Please select one option" name="vaccination-status-we-only-ask-to-know-what-destination-to-advise-all-information-is-private">
			<option label="I am fully vaccinated with either Pfizer/BioNTech, Moderna, or J&amp;J and it has been two weeks since my last shot" value="i-am-fully-vaccinated-with-either-pfizerbiontech-moderna-or-jj-and-it-has-been-two-weeks-since-my-last-shot">I am fully vaccinated with either Pfizer/BioNTech, Moderna, or J&amp;J and it has been two weeks since my last shot</option>
			<option label="I have had my first shot of Pfizer/BioNTech or Modern." value="i-have-had-my-first-shot-of-pfizerbiontech-or-modern">I have had my first shot of Pfizer/BioNTech or Modern.</option>
			<option label="I am not vaccinated" value="i-am-not-vaccinated" selected="true">I am not vaccinated</option>
		</field>
		<field type="textarea" label="Does anyone is the traveling group have any allegies?" description="For each individual this applys for  please state name and allergy." name="does-anyone-is-the-traveling-group-have-any-allegies" className="form-control"/>
		<field type="date" required="true" label="Earliest you can depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="earliest-you-can-depart" className="form-control"/>
		<field type="date" label="Latest you can return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="latest-you-can-return" className="form-control"/>
		<field type="text" label="How many nights would you like the trip to be?" name="how-many-nights-would-you-like-the-trip-to-be" subtype="text" className="form-control"/>
		<field type="textarea" required="true" label="Number of travelers as they appear on passport and please include dates of birth?" name="number-of-travelers-and-their-ages" className="form-control"/>
		<field type="checkbox-group" label="For this trip are you interested in:" description="Check all that apply." name="are-you-interested-in" other="true">
			<option label="Hotel" value="hotel">Hotel</option>
			<option label="Air" value="air">Air</option>
			<option label="Rental Car" value="rental-car">Rental Car</option>
			<option label="Escorted Tour" value="escorted-tour">Escorted Tour</option>
			<option label="Cruise" value="cruise">Cruise</option>
			<option label="All Inclusive Resort (where available)" value="all-inclusive-resort-where-available">All Inclusive Resort (where available)</option>
			<option label="Rail Vacation" value="rail-vacation">Rail Vacation</option>
			<option label="Custom Itinerary (not escorted) *Please see below" value="custom-itinerary-not-escorted-please-see-below">Custom Itinerary (not escorted) *Please see below</option>
		</field>
		<field type="paragraph" subtype="p" label="*Custom itineraries (usually defined as a trip with more than one destination and/or several components) require a fee, starting at $250 for trips up to 7 nights, and $350 for trips that are 8+ nights in length (see website for details and service menu).&amp;nbsp; This covers the time involved in researching and crafting a highly-customized travel experience for you.&amp;nbsp; If you choose, I will also make and manage the bookings for you."/>
		<field type="text" label="If you need air included, what is your departure city?" description="Where will you be flying from?" name="if-you-need-air-included-what-is-your-departure-city" subtype="text" className="form-control"/>
		<field type="text" label="Preferred airline(s) and class of service, if any?" name="preferred-airlines-if-any" subtype="text" className="form-control"/>
		<field type="radio-group" required="true" label="Would you like travel protection included in your package?" description="Emergencies are always a surprise!" name="would-you-like-travel-protection-included-in-your-package">
			<option label="Yes" value="yes">Yes</option>
			<option label="No (or not yet)" value="no-or-not-yet">No (or not yet)</option>
		</field>
		<field type="radio-group" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget">
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>
			<option label="$10,000+" value="10000">$10,000+</option>
		</field>
		<field type="textarea" label="Budget details" name="budget-details" className="form-control"/>
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">
			<option label="Value" value="value">Value</option>
			<option label="Moderate" value="moderate">Moderate</option>
			<option label="Luxury" value="luxury">Luxury</option>
			<option label="Boutique" value="boutique">Boutique</option>
		</field>
		<field type="radio-group" label="Which of these is the TOP priority" name="which-of-these-are-the-top-3-priority">
			<option label="Best experience for the money" value="best-experience-for-the-money">Best experience for the money</option>
			<option label="Lowest Price" value="lowest-price">Lowest Price</option>
			<option label="Authentic, immersive experiences" value="authentic-immersive-experiences">Authentic, immersive experiences</option>
			<option label="Best accommodations" value="best-accommodations">Best accommodations</option>
			<option label="Basic accommodations: clean, safe, well-located" value="basic-accommodations-clean-safe-welllocated">Basic accommodations: clean, safe, well-located</option>
			<option label="Small, cozy hotel (more boutique)" value="small-cozy-hotel-more-boutique">Small, cozy hotel (more boutique)</option>
			<option label="Large property with on-site dining &amp; amenities" value="large-property-with-onsite-dining-amenities">Large property with on-site dining &amp; amenities</option>
			<option label="Other" value="other">Other</option>
		</field>
		<field type="textarea" label="Are there any hotel features or amenities that you would prefer to (or must) have?" name="are-there-any-hotel-features-or-amenities-that-you-would-prefer-to-or-must-have" className="form-control"/>
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">
			<option label="Romantic" value="romantic">Romantic</option>
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>
			<option label="Party" value="party">Party</option>
			<option label="Local culture" value="local-culture">Local culture</option>
			<option label="Family friendly" value="family-friendly">Family friendly</option>
			<option label="Food and wine" value="food-wine">Food and wine</option>
		</field>
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">
			<option label="Beach and water" value="beach-water">Beach and water</option>
			<option label="Gambling" value="gambling">Gambling</option>
			<option label="Scuba" value="scuba">Scuba</option>
			<option label="Adventure activities" value="adventure">Adventure activities</option>
			<option label="Golf" value="golf">Golf</option>
			<option label="Nightlife" value="nightlife">Nightlife</option>
			<option label="Arts and theater" value="art-theater">Arts and theater</option>
		</field>
		<field type="radio-group" label="Which of these are you interested in?" name="which-of-these-are-you-interested-in">
			<option label="Just the highlights and/or main attractions" value="just-the-highlights-andor-main-attractions">Just the highlights and/or main attractions</option>
			<option label="Guided Tours" value="guided-tours">Guided Tours</option>
			<option label="Private Tours" value="private-tours">Private Tours</option>
			<option label="Just the tickets/ no guide" value="just-the-tickets-no-guide">Just the tickets/ no guide</option>
		</field>
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>
		<field type="radio-group" label="Will you be using an Amex Platinum or Centurion card (for possible extra perks)?" name="will-you-be-using-an-amex-platinum-or-centurion-card-for-possible-extra-perks">
			<option label="yes" value="yes">yes</option>
			<option label="no" value="no" selected="true">no</option>
		</field>
		<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"/>
		<field type="header" subtype="h1" label="Known Traveler Number"/>
		<field type="text" label="Text Field" name="text-1640638871550" value="Please list your KTN or Global Entry number here." subtype="text" className="form-control"/>
		<field type="textarea" label="Text Area" name="textarea-1640638911131" className="form-control"/>
		<field type="header" subtype="h3" label="Package Pricing / Loyalty Programs"/>
		<field type="paragraph" subtype="p" label="I work with many wholesalers who offer package prices, which are great because you will usually pay significantly less than booking the accommodations, flights, and transportation separately. The payment schedules are often more flexible as well."/>
		<field type="paragraph" subtype="p" label="It is important to note that the rules can be different for these contracted rates so if you have status with an airline or hotel brand and/or are looking to accrue points, I need to know so that we can discuss your priorities."/>
		<field type="radio-group" label="Which is more important:" name="which-is-more-important">
			<option label="Best Price" value="best-price">Best Price</option>
			<option label="Loyalty program status/accruing points" value="loyalty-program-statusaccruing-points">Loyalty program status/accruing points</option>
		</field>
		<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"/>
		<field type="radio-group" label="I have requested that Journeys Travel Company, LLC (&quot;Agency&quot;) make one or more travel bookings on my behalf. As the worldwide COVID-19 pandemic remains ongoing at this time, I acknowledge that for this reason, and other reasons not reasonably forseeable at this time, these travel plans may be interrupted or canceled but the supplier that is providing them, a government entity or other third-party over which Agency has no control. I further acknowledge that the supplier's own cancellation, rebooking, and refund policies, subject to any applicable law that is now or may later be in effect, will govern my rights and remedies, including my right to receive a refund, in such an event. Moreover, I understand that should I elect to purchase travel insurance, the terms of the policy will dictate whether, and to what extent, coverage for any financial loss may exist under the circumstances. By signing below, I hereby agree to hold Agency harmless and release it from any and all liability for any damages, including but not limited to monetary losses, I may incur as a result of such interruption or cancellation of these travel plans. The bulk of our business is conducted via the use of credit or debit cards including MasterCard, Visa, Discover, and American Express. You are required to provide authorization to apply funds to arrangements in your name for every transaction for your trip. Your authorization, be it the full formal authorization or the shortened text version of authorization is a binding agreement for us to charge your card and as such, you waive any right to chargeback in the case of cancellation for any cause (except fraud), including a force majeure event, and agree to the refund policies dictated by the travel supplier. In the event a client attempts to chargeback, reverse, or recollect a payment already made without our express written consent, we reserve the right to collect all additional costs, fees, and expenses associated with such chargeback, reversal or recollection including, without limitation, attorney fees and Agency's rate of $50.00 per hour. The current travel environment is changing rapidly. Agency has provided you with the latest information at their disposal regarding the policies related to destination entry requirements as well as policies related to each travel component booked through Agency. You agree to hold harmless Agency if any changes occur between notice given and time of travel. Agency recommends every passenger register with the www.travel.us.gov/STEP program. It is your responsibility to register independently as this is a government locator program designed to track US travelers abroad. It is also your responsibility to monitor recommendations from sources such as the Center for Disease Control and the World Healthe Organization and make an informed decision regarding your travel plans. The current pandemic may limit the services and amenities available in your destination. Experiences and activities may be limited or unavailable. Dining and beverage options may also be limited at the hotel, resort, or cruise line's discretion. By signing this you understand that these limitations are outside Agency's control and does not release you from payment terms and conditions as dictated by the travel suppliers." name="i-have-requested-that-journeys-travel-company-llc-agency-make-one-or-more-travel-bookings-on-my-behalf-as-the-worldwide-covid19-pandemic-remains-ongoing-at-this-time-i-acknowledge-that-for-this-reason-and-other-reasons-not-reasonably-forseeable-at-this-time-these-travel-plans-may-be-interrupted-or-canceled-but-the-supplier-that-is-providing-them-a-government-entity-or-other-thirdparty-over-which-agency-has-no-control-i-further-acknowledge-that-the-suppliers-own-cancellation-rebooking-and-refund-policies-subject-to-any-applicable-law-that-is-now-or-may-later-be-in-effect-will-govern-my-rights-and-remedies-including-my-right-to-receive-a-refund-in-such-an-event-moreover-i-understand-that-should-i-elect-to-purchase-travel-insurance-the-terms-of-the-policy-will-dictate-whether-and-to-what-extent-coverage-for-any-financial-loss-may-exist-under-the-circumstances-by-signing-below-i-hereby-agree-to-hold-agency-harmless-and-release-it-from-any-and-all-liability-for-any-damages-including-but-not-limited-to-monetary-losses-i-may-incur-as-a-result-of-such-interruption-or-cancellation-of-these-travel-plans-the-bulk-of-our-business-is-conducted-via-the-use-of-credit-or-debit-cards-including-mastercard-visa-discover-and-american-express-you-are-required-to-provide-authorization-to-apply-funds-to-arrangements-in-your-name-for-every-transaction-for-your-trip-your-authorization-be-it-the-full-formal-authorization-or-the-shortened-text-version-of-authorization-is-a-binding-agreement-for-us-to-charge-your-card-and-as-such-you-waive-any-right-to-chargeback-in-the-case-of-cancellation-for-any-cause-except-fraud-including-a-force-majeure-event-and-agree-to-the-refund-policies-dictated-by-the-travel-supplier-in-the-event-a-client-attempts-to-chargeback-reverse-or-recollect-a-payment-already-made-without-our-express-written-consent-we-reserve-the-right-to-collect-all-additional-costs-fees-and-expenses-associated-with-such-chargeback-reversal-or-recollection-including-without-limitation-attorney-fees-and-agencys-rate-of-5000-per-hour-the-current-travel-environment-is-changing-rapidly-agency-has-provided-you-with-the-latest-information-at-their-disposal-regarding-the-policies-related-to-destination-entry-requirements-as-well-as-policies-related-to-each-travel-component-booked-through-agency-you-agree-to-hold-harmless-agency-if-any-changes-occur-between-notice-given-and-time-of-travel-agency-recommends-every-passenger-register-with-the-wwwtravelusgovstep-program-it-is-your-responsibility-to-register-independently-as-this-is-a-government-locator-program-designed-to-track-us-travelers-abroad-it-is-also-your-responsibility-to-monitor-recommendations-from-sources-such-as-the-center-for-disease-control-and-the-world-healthe-organization-and-make-an-informed-decision-regarding-your-travel-plans-the-current-pandemic-may-limit-the-services-and-amenities-available-in-your-destination-experiences-and-activities-may-be-limited-or-unavailable-dining-and-beverage-options-may-also-be-limited-at-the-hotel-resort-or-cruise-lines-discretion-by-signing-this-you-understand-that-these-limitations-are-outside-agencys-control-and-does-not-release-you-from-payment-terms-and-conditions-as-dictated-by-the-travel-suppliers">
			<option label="I agree" value="i-agree">I agree</option>
			<option label="I disagree" value="i-disagree">I disagree</option>
		</field>
		<field type="header" subtype="h1" label="Totally optional questions, to help me get to know you.&amp;nbsp; Answer some, none, or all!"/>
		<field type="text" label="What trip would you take if you won the lottery (or struck oil)?" name="what-trip-would-you-take-if-you-won-the-lottery-or-struck-oil" subtype="text" className="form-control"/>
		<field type="text" label="What are your hobbies?" name="what-are-your-hobbies" subtype="text" className="form-control"/>
		<field type="text" label="What are your favorite beverages?" name="what-are-your-favorite-beverages" subtype="text" className="form-control"/>
		<field type="text" label="What is your favorite food and/or type of cuisine?" name="what-is-your-favorite-food-andor-type-of-cuisine" subtype="text" className="form-control"/>
		<field type="textarea" label="What was your favorite vacation?&amp;nbsp; What made it your favorite?&amp;nbsp;" name="what-was-your-favorite-vacation-what-made-it-your-favorite-" className="form-control"/>
		<field type="textarea" label="What was your least favorite destination/vacation?&amp;nbsp; Feel free to elaborate..." name="what-was-your-least-favorite-destinationvacation-feel-free-to-elaborate" className="form-control"/>
		<field type="text" label="What movie makes you want to travel?&amp;nbsp; Feel free to list as many as you can think of..." name="what-movie-makes-you-want-to-travel-feel-free-to-list-as-many-as-you-can-think-of" subtype="text" className="form-control"/>
	</fields>
</form-template>