Share your information with Nita K. Pitts

Nita K. Pitts

DreamKey Vacations, LLC

<html>
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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Let&#39;s coordinate your Mexico, Caribbean or Jamaica getaway!"/>&#13;
		<field type="text" required="true" label="What is your Departure City?" name="what-is-your-departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your Destination of Choice?&amp;nbsp; List one per Request" description="Where do you want to go?" name="what-is-your-destination-of-choice-" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of Arrival" name="date-of-arrival" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of Return" name="date-of-return" className="form-control"/>&#13;
		<field type="radio-group" required="true" 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" 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="Suffix" name="suffix" 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="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="date" required="true" label="Date of Birth" name="birthday" className="form-control"/>&#13;
		<field type="text" required="true" label="How many adults 18+ and how many children (list ages of children)?" placeholder="Example 1: 2 Adults  3 children 14  8  3" name="how-many-adults-18-and-how-many-children-list-ages-of-children" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How many rooms needed?" inline="true" name="how-many-rooms-or-cabins-needed">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5+" value="5">5+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your per person budget for all travelers in your party?&amp;nbsp; &amp;nbsp; &amp;nbsp;Please be Realistic!" description="Amount willing to pay for your trip." name="what-is-your-budget-for-all-travelers-in-your-party-please-be-realistic" other="true">&#13;
			<option label="$500 - $999" value="500-999">$500 - $999</option>&#13;
			<option label="$1000 - $1999" value="1000-1999">$1000 - $1999</option>&#13;
			<option label="$2000 - $2999" value="2000-2999">$2000 - $2999</option>&#13;
			<option label="$3000 - $3999" value="3000-3999">$3000 - $3999</option>&#13;
			<option label="$4000 - $4999" value="4000-4999">$4000 - $4999</option>&#13;
			<option label="$5000+" value="5000">$5000+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Flights Needed?" name="flights-needed">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No, I'll book my own" value="no-ill-book-my-own">No, I'll book my own</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Passport Status" name="passport-status" other="true">&#13;
			<option label="I have a valid passport" value="i-have-a-valid-passport">I have a valid passport</option>&#13;
			<option label="My passport is in process / I will have it before travel" value="my-passport-is-in-process-i-will-have-it-before-travel">My passport is in process / I will have it before travel</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="List shirt sizes for family of 4." description="Extra cost for additional shirt sizes." name="list-shirt-sizes-for-family-of-4" subtype="text" className="form-control field-hidden"/>&#13;
		<field type="textarea" label="Comments: What else would you like for us to know?" placeholder="Special requests   medical and/or accessibility needs  allergies, destination not listed, etc" name="notes" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How did you hear about us?" name="how-did-you-hear-about-us">&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Referred by Friend" value="referred-by-friend">Referred by Friend</option>&#13;
			<option label="Search Engine" value="search-engine">Search Engine</option>&#13;
			<option label="DreamKey Vacations: This is not my 1st trip" value="dreamkey-vacations-this-is-not-my-1st-trip">DreamKey Vacations: This is not my 1st trip</option>&#13;
		</field>&#13;
		<field type="text" label="If you were referred, please list their full name and email address" name="if-you-were-referred-please-list-their-full-name-and-email-address" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Weekender Color Preference (for Mexico/Caribbean)" name="weekender-color-preference" className="field-hidden">&#13;
			<option label="Black" value="black">Black</option>&#13;
			<option label="Beige" value="beige">Beige</option>&#13;
			<option label="N/A" value="na">N/A</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Weekender Pack Acknowledgment (for Mexico/Caribbean)" name="weekender-pack-acknowledgment" className="field-hidden">&#13;
			<option label="I understand that the Exclusive Travel Weekender Pack offer is not fulfilled until after the final payment due date. I understand that I must allow sufficient time for shipping and handling. I also understand that the Weekender style and color may vary based on availability, and a comparable item of equal value may be substituted if needed." value="i-understand-that-the-exclusive-travel-weekender-pack-offer-is-not-fulfilled-until-after-the-final-payment-due-date-i-understand-that-i-must-allow-sufficient-time-for-shipping-and-handling-i-also-understand-that-the-weekender-style-and-color-may-vary-based-on-availability-and-a-comparable-item-of-equal-value-may-be-substituted-if-needed">I understand that the Exclusive Travel Weekender Pack offer is not fulfilled until after the final payment due date. I understand that I must allow sufficient time for shipping and handling. I also understand that the Weekender style and color may vary based on availability, and a comparable item of equal value may be substituted if needed.</option>&#13;
			<option label="N/A" value="na">N/A</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1771718000080" rule="eyJ3aGVuRmllbGQiOiJ3aGF0LWlzLXlvdXItZGVzdGluYXRpb24tb2YtY2hvaWNlLSIsIndoZW5Db25kaXRpb24iOiJlcXVhbHMiLCJ3aGVuVmFsdWUiOiJKYW1haWNhIiwidGhlbkFjdGlvbiI6InNob3ciLCJ0aGVuRmllbGRzIjpbImNoZWNrYm94LWdyb3VwLTE3NjkxMzM2NjUxOTgiXSwidGhlbkZpZWxkc0luZm8iOlt7Im5hbWUiOiJjaGVja2JveC1ncm91cC0xNzY5MTMzNjY1MTk4IiwibGFiZWwiOiJDbHViIE1vYmF5IFZJUCBEZXBhcnR1cmUgTG91bmdlIChmb3IgSmFtYWljYSkifV19"/>&#13;
		<field type="checkbox-group" required="true" label="Club Mobay VIP Departure Lounge (for Jamaica)" name="checkbox-group-1769133665198" className="field-hidden">&#13;
			<option label="I understand that the Club Mobay Departure Lounge Access is provided after my trip is paid in full by the final payment due date. I understand that this service is subject to availability at the time of booking and a credit may be substituted if the lounge is full. I also understand that I must provide my flight information promptly to check for availability, as this service sells out quickly." value="i-understand-that-the-club-mobay-departure-lounge-access-is-provided-after-my-trip-is-paid-in-full-by-the-final-payment-due-date-i-understand-that-this-service-is-subject-to-availability-at-the-time-of-booking-and-a-credit-may-be-substituted-if-the-lounge-is-full-i-also-understand-that-i-must-provide-my-flight-information-promptly-to-check-for-availability-as-this-service-sells-out-quickly">I understand that the Club Mobay Departure Lounge Access is provided after my trip is paid in full by the final payment due date. I understand that this service is subject to availability at the time of booking and a credit may be substituted if the lounge is full. I also understand that I must provide my flight information promptly to check for availability, as this service sells out quickly.</option>&#13;
			<option label="N/A" value="na">N/A</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="Please allow up to 3 business days for a response after submission."/>&#13;
		<field type="pageBreak" name="pageBreak-1771718428593" next="Next" previous="Previous"/>&#13;
	</fields>&#13;
</form-template>
  </body>
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