Share your information with Kelly Purnell

Kelly Purnell

Clearscape Travel

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    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h1" label="I would love to know more about what your next travel needs might be, and if I am the right fit. Please review below and fill me in on a few details through the below form. Once I hear back we can get started and chat live!"/>&#13;
		<field type="text" 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" label="Preferred departure date?" 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="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" label="How many days would you like to travel?" name="text-1754599781590" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What is your departure city or possible airports you can depart from?&amp;nbsp;" description="Where will you be flying from?" name="text-1731350685595" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many travelers? Please list names of adults and children along with dates of birth." name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What are the important highlights for the trip? Any must sees or dos? Desired activities?&amp;nbsp;" description="Cities   places  experiences you are looking for?" name="text-1731351012426" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Dietary or accessibility issues I need to be aware of? If yes, please describe and note traveler. activities?&amp;nbsp;" name="text-1754599887797" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What else would you like me to know?" name="text-1738764490697" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy" value="value">Economy</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="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>