Share your information with Natohya Mallory

Natohya Mallory

Come On and Travel, Concierge Travel Service

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="2026 Travel , What&#39;s Your Next Adventure?"/>&#13;
		<field type="header" subtype="h2" label="Full name (as it appears on travel documents)"/>&#13;
		<field type="text" required="true" label="First name" description="as listed on passport" 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" description="as listed on passport" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of Birth" description="as listed on passport" name="date-of-birth" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Primary Travelers Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country" name="address-country" 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="radio-group" required="true" label="Where is your next 2026 Adventure?" description="More trip details will be sent to you." name="budget" other="true">&#13;
			<option label="🌞 Juneteenth Celebration in Cancún – June 19–22, 2026" value="-juneteenth-celebration-in-cancn-june-1922-2026">🌞 Juneteenth Celebration in Cancún – June 19–22, 2026</option>&#13;
			<option label="🌴 Sandals Dunn’s River – July 15–19, 2026" value="-sandals-dunns-river-july-1519-2026">🌴 Sandals Dunn’s River – July 15–19, 2026</option>&#13;
			<option label="🎉 Martha’s Vineyard Getaway – August 1–8, 2026 🎉- shorter dates available" value="-marthas-vineyard-getaway-august-18-2026-shorter-dates-available">🎉 Martha’s Vineyard Getaway – August 1–8, 2026 🎉- shorter dates available</option>&#13;
			<option label="🚢 Star of the Seas Cruise – Nov. 8–15, 2026 🎉" value="-star-of-the-seas-cruise-nov-815-2026-">🚢 Star of the Seas Cruise – Nov. 8–15, 2026 🎉</option>&#13;
		</field>&#13;
		<field type="text" label="How many traveling with you? (Roommates or additional rooms-let me know)" name="list-additional-traveler-name-and-date-of-birth" subtype="text" className="form-control"/>&#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 and water" value="beach-water">Beach and water</option>&#13;
			<option label="Casino" value="casino">Casino</option>&#13;
			<option label="Social Gatherings" value="social-gatherings">Social Gatherings</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</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="Party Boat" value="party-boat">Party Boat</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="text" label="Would you like information on a different destination?&amp;nbsp;" description="Come On and Travel can curate a personalized trip just for you." name="destination" 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;
	</fields>&#13;
</form-template>
  </body>
</html>