Brenda Ajay

Ajay Travel LLC, Altoona, PA

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Thinking about a trip to Italy?"/>&#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" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="When would be the ideal time for you to travel?" name="when-would-be-the-ideal-month-for-you-to-travel" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many adults are in your party?" name="how-many-adults-are-in-your-party" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many children are in your party? (please list their ages)" name="how-many-children-are-in-your-party-please-list-their-ages" subtype="text" className="form-control"/>&#13;
		<field type="select" label="What kind of vacation are you interested in?" name="what-kind-of-vacation-are-you-interested-in" multiple="multiple" className="form-control">&#13;
			<option label="Individual tour - just myself and my traveling companions" value="individual-tour-just-myself-and-my-traveling-companions" selected="selected">Individual tour - just myself and my traveling companions</option>&#13;
			<option label="Fully guided, small group tour (less than 24 people)" value="fully-guided-small-group-tour-less-than-24-people">Fully guided, small group tour (less than 24 people)</option>&#13;
			<option label="Fully guided, classic tour (up to 55 people)" value="fully-guided-classic-tour-up-to-55-people">Fully guided, classic tour (up to 55 people)</option>&#13;
			<option label="Extended stay with villa or vacation rental" value="extended-stay-with-villa-or-vacation-rental">Extended stay with villa or vacation rental</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What destinations are you interested in?" name="what-destinations-are-you-interested-in" other="true">&#13;
			<option label="Rome" value="rome" selected="selected">Rome</option>&#13;
			<option label="Florence" value="florence">Florence</option>&#13;
			<option label="Venice" value="venice">Venice</option>&#13;
			<option label="Tuscany" value="tuscany">Tuscany</option>&#13;
			<option label="Amalfi Coast" value="amalfi-coast">Amalfi Coast</option>&#13;
			<option label="Italian Riviera" value="italian-riviera">Italian Riviera</option>&#13;
			<option label="Italian Lakes" value="italian-lakes">Italian Lakes</option>&#13;
			<option label="Piedmont Wine Region" value="piedmont-wine-region">Piedmont Wine Region</option>&#13;
			<option label="Italian Alps - Dolomites" value="italian-alps-dolomites">Italian Alps - Dolomites</option>&#13;
			<option label="Southern Italy - Puglia, Matera, Bari" value="southern-italy-puglia-matera-bari">Southern Italy - Puglia, Matera, Bari</option>&#13;
			<option label="Sicily" value="sicily">Sicily</option>&#13;
			<option label="ITALY and GREECE" value="italy-and-greece">ITALY and GREECE</option>&#13;
		</field>&#13;
		<field type="text" label="Are you interested in a specific tour featured on our website, email or social media? Please describe" name="are-you-interested-in-a-specific-tour-featured-on-our-website-email-or-social-media-please-describe" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
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