Share your information with Julie Antell

Julie Antell

Escapes By Julie

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Travel Interest From"/>&#13;
		<field type="header" subtype="h3" label="Please tell me a little about you and your trip ideas and then I&#39;ll contact you to schedule a complimentary consulation."/>&#13;
		<field type="header" subtype="h3" label="Full name"/>&#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 required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Address"/>&#13;
		<field type="text" 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" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" 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" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What type of trip are you interested in?" name="what-type-of-trip-are-you-interested-in" other="true">&#13;
			<option label="All-inclusive resort" value="allinclusive-resort">All-inclusive resort</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Europe/International" value="europeinternational">Europe/International</option>&#13;
			<option label="Hotel (non all-inclusive)" value="hotel-non-allinclusive">Hotel (non all-inclusive)</option>&#13;
			<option label="House/Villa rental" value="housevilla-rental">House/Villa rental</option>&#13;
			<option label="Disney/Universal" value="disneyuniversal">Disney/Universal</option>&#13;
			<option label="Not sure yet, help me decide!" value="not-sure-yet-help-me-decide">Not sure yet, help me decide!</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Where would you like to go?" 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?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#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="text" required="true" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" 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">&#13;
			<option label="Less than $1500" value="less-than-1500">Less than $1500</option>&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</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="radio-group" required="true" label="I would like to have my complimentary consultation:" description="After I receive this form  I will contact you for a complimentary consultation to review your information, clarify details, discuss specifics, and get to know each other so I can create a perfectly matched itinerary for you!" name="radio-group-1771023349492">&#13;
			<option label="Via Phone Call" value="via-phone-call">Via Phone Call</option>&#13;
			<option label="Via Zoom" value="via-zoom">Via Zoom</option>&#13;
			<option label="Email me the discovery form, I don't want to meet" value="email-me-the-discovery-form-i-dont-want-to-meet">Email me the discovery form, I don't want to meet</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>