Share your information with Becky Hackett

Becky Hackett

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    <form-template>&#13;
	<fields>&#13;
		<field type="paragraph" subtype="p" label="Tell me a little bit about what you are looking for on your Cruise vacation!"/>&#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="text" required="true" label="State of Residence" name="state-of-residence" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="The purpose of this cruise vacation is" name="the-purpose-of-this-cruise-vacation-is">&#13;
			<option label="Adventure/Expedition" value="adventureexpedition">Adventure/Expedition</option>&#13;
			<option label="Celebrating a Special Occasion" value="celebrating-a-special-occasion">Celebrating a Special Occasion</option>&#13;
			<option label="Making Memories with Family and/or Friends" value="making-memories-with-family-andor-friends">Making Memories with Family and/or Friends</option>&#13;
			<option label="Relax and Recharge" value="relax-and-recharge">Relax and Recharge</option>&#13;
			<option label="Romance" value="romance">Romance</option>&#13;
			<option label="Just for Fun!" value="just-for-fun">Just for Fun!</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What type of cruise do you want?" name="what-type-of-cruise-do-you-want">&#13;
			<option label="Ocean" value="ocean">Ocean</option>&#13;
			<option label="River" value="river">River</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What destination(s) do you have in mind for this trip?" name="what-destinations-do-you-have-in-mind-for-this-trip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Ports you can depart from?" name="ports-you-can-depart-from" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Is this your first ever cruise?" name="is-this-your-first-ever-cruise" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Which cruise lines have you sailed with before?" name="which-cruise-lines-have-you-sailed-with-before" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Do you have a loyalty number with any cruise line?" name="do-you-have-a-loyalty-number-with-any-cruise-line" 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="text" label="Are your dates flexible?" name="are-your-dates-flexible" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="What is your total budget range (not including airfare)?" placeholder="Select from the list" name="what-is-your-total-budget-range" className="form-control">&#13;
			<option label="$3,000-$5,000" value="30005000">$3,000-$5,000</option>&#13;
			<option label="$5,000-$8,000" value="50008000">$5,000-$8,000</option>&#13;
			<option label="$8,000-$10,000" value="800010000">$8,000-$10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="select" label="Do you qualify for any discounts?" placeholder="Select" name="do-you-qualify-for-any-discounts" className="form-control">&#13;
			<option label="Military" value="military">Military</option>&#13;
			<option label="Fire/EMT/Law Enforcement" value="fireemtlaw-enforcement">Fire/EMT/Law Enforcement</option>&#13;
			<option label="Senior (55 or older)" value="senior-55-or-older">Senior (55 or older)</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What best describes your hotel/cruise preference?" placeholder="Select" name="what-best-describes-your-hotelcruise-preference" className="form-control">&#13;
			<option label="Value" value="value">Value</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;
		</field>&#13;
		<field type="select" label="Cabin Preference" placeholder="Select" name="cabin-preference" className="form-control">&#13;
			<option label="Inside/Interior (no window/balcony)" value="insideinterior-no-windowbalcony">Inside/Interior (no window/balcony)</option>&#13;
			<option label="Ocean View (porthole window only)" value="ocean-view-porthole-window-only">Ocean View (porthole window only)</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Connecting Cabins" value="connecting-cabins">Connecting Cabins</option>&#13;
		</field>&#13;
		<field type="text" label="Number of cabins and location preferences -Do they need to connect, or is side-by-side or just nearby ok?" name="number-of-cabins-and-location-preferences-do-they-need-to-connect-or-is-sidebyside-or-just-nearby-ok" subtype="text" className="form-control"/>&#13;
		<field type="text" label="&amp;nbsp;If you want a specific location on the ship or specific cabin number, please let me know. (Deck number, Ship location such as Forward, AFT (back), Midship, Left side(Port) or Right Side (Starboard)." name="-if-you-want-a-specific-location-on-the-ship-or-specific-cabin-number-please-let-me-know-deck-number-ship-location-such-as-forward-aft-back-midship-left-sideport-or-right-side-starboard" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Traveler Details"/>&#13;
		<field type="text" required="true" label="How many adult travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many child travelers?" name="text-1739413236800" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="If traveling internationally, does everyone in your group have a valid passport for at least 6 months from the travel date? Clients will be asked to provide passport information prior to booking for trips that require a passport.&amp;nbsp;" name="if-traveling-internationally-does-everyone-in-your-group-have-a-valid-passport-for-at-least-6-months-from-the-travel-date-clients-will-be-asked-to-provide-passport-information-prior-to-booking-for-trips-that-require-a-passport-for-more-information-on-passport-requirements-please-visit-httpstravelstategovcontenttravelenpassportshtml-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No, but in the process of applying/renewing" value="no-but-in-the-process-of-applyingrenewing">No, but in the process of applying/renewing</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Unknown" value="unknown">Unknown</option>&#13;
		</field>&#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="text" required="true" label="How did you hear about me?" name="how-did-you-hear-about-me" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>