<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Full Name"/> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="checkbox-group" label="By checking this box, you agree to receive SMS messages from Pride Travelers about travel services and updates. Msg &amp; data rates may apply. Reply STOP to unsubscribe at any time. We take privacy seriously and will always protect your information. View our privacy policy by visiting https://pridetravelers.com/privacy-policy/" name="by-checking-this-box-you-agree-to-receive-sms-messages-from-pride-travelers-about-travel-services-and-updates-msg--data-rates-may-apply-reply-stop-to-unsubscribe-at-any-time-we-take-privacy-seriously-and-will-always-protect-your-information-view-our-privacy-policy-by-visiting-httpspridetravelerscomprivacy-policy"> <option label="I agree" value="SMS-Agreement">I agree</option> </field> <field type="radio-group" required="true" label="Gender" name="gender"> <option label="F" value="female">F</option> <option label="M" value="male">M</option> <option label="X" value="other">X</option> </field> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="date" label="Wedding anniversary" name="wedding-anniversary" className="form-control"/> <field type="paragraph" subtype="p"/> <field type="header" subtype="h2" label="Address"/> <field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/> <field type="paragraph" subtype="p"/> <field type="header" subtype="h2" label="Travel Preferences"/> <field type="radio-group" label="Seat preference" name="seat-preference"> <option label="Window" value="window">Window</option> <option label="Aisle" value="aisle">Aisle</option> <option label="Opposite aisle" value="opposite aisle">Opposite aisle</option> </field> <field type="radio-group" label="Bed preference" name="bed-preference"> <option label="King" value="king">King</option> <option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option> </field> <field type="text" label="Meal preference" name="meal-preference" subtype="text" className="form-control"/> <field type="radio-group" label="Hotel preference" name="hotel-preference"> <option label="Economy" value="value">Economy</option> <option label="Moderate" value="moderate">Moderate</option> <option label="Luxury" value="luxury">Luxury</option> <option label="Boutique" value="boutique">Boutique</option> </field> <field type="checkbox-group" label="Vibe preferences" name="vibe-preference"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option> <option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option> <option label="Party" value="party">Party</option> <option label="Local culture" value="local-culture">Local culture</option> <option label="Family friendly" value="family-friendly">Family friendly</option> <option label="Food and wine" value="food-wine">Food and wine</option> <option label="Multi-generational" value="multi-generational">Multi-generational</option> <option label="Adventure" value="adventure">Adventure</option> <option label="LGBT" value="lgbt">LGBT</option> </field> <field type="checkbox-group" label="Activity preferences" name="activity-preferences"> <option label="Beach and water" value="beach-water">Beach and water</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Scuba" value="scuba">Scuba</option> <option label="Adventure activities" value="adventure">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theatre" value="art-theatre">Arts and theatre</option> </field> <field type="select" required="true" label="How did you hear about us?" name="how-did-you-hear-about-us" className="form-control"> <option label="" value=""/> <option label="Google" value="google">Google</option> <option label="Facebook" value="facebook">Facebook</option> <option label="Yelp" value="yelp">Yelp</option> <option label="TikTok" value="tiktok">TikTok</option> <option label="Client Referral" value="client-referral">Client Referral</option> <option label="Other" value="other">Other</option> </field> <field type="text" label="If you were referred by one of our incredible clients, please enter their name so we can thank them!" name="referred-by" subtype="text" className="form-control"/> <field type="paragraph" subtype="p"/> <field type="header" subtype="h1" label="Pride Travelers Client Agreement"/> <field type="paragraph" subtype="p" label="When you retain Pride Travelers to help plan your travel, you're hiring a professional travel advisor to ensure that your trip is tailored to your taste, preferences, and budget. You get the benefit of our skill, experience and training, our professional relationships, and our industry connections. Our Professional Services Fee covers your consultation, our research and recommendations, preparation of quotes and itineraries, reserving and booking each element of your trip, securing quotes for comprehensive travel insurance, administration of your booking from deposit to departure, and follow-up post-trip with suppliers (as needed)."/> <field type="paragraph" subtype="p" label="By checking the box below and submitting this form, you acknowledge that you are hiring us to plan your trip and that you have read and agree to our Terms and Conditions of booking, which are located at: https://pridetravelers.com/terms/"/> <field type="checkbox-group" required="true" label="Client Agreement" name="by-checking-the-box-i-agree-to-being-contacted-via-emailphone-by-one-of-our-trusted-travel-agents"> <option label="I Agree" value="i-agree">I Agree</option> </field> <field type="paragraph" subtype="p"/> <field type="header" subtype="h1" label="Travel Insurance Acknowledgement"/> <field type="paragraph" subtype="p" label="Emergencies can happen when you least expect them. Pride Travelers highly recommends that all clients purchase a travel insurance policy to protect their investment in their travel. Cruise lines, airlines, hotels, and tour operators all charge high penalties for cancellation, ranging from the full deposit to no refund at all. And, keep in mind that most health insurance policies will not cover you when you are out of the country. Travel insurance can protect you in the event of Trip Cancellation, Trip Delay, Trip Interruption, Missed Connection, Baggage Loss, Theft or Damage, Baggage Delay, Emergency Medical and Dental Expenses, and Emergency Medical Transportation, among other unforeseen circumstances.&nbsp;"/> <field type="paragraph" subtype="p" label="Please also note that in order for you to obtain coverage for certain pre-existing conditions, or for supplier default, your policy must be purchased at the time of booking or shortly thereafter (depending on the terms of the policy).&nbsp;"/> <field type="paragraph" subtype="p" label="Please understand that we are not registered insurance agents, and cannot legally provide specific advice or information regarding insurance. We will gladly secure a quote for you, upon request, and if Pride Travelers does not, or is not legally able to secure coverage on your behalf, it is our strong recommendation that you purchase a policy on your own.&nbsp;"/> <field type="paragraph" subtype="p" label="I acknowledge that Pride Travelers has recommended or offered travel insurance protection to me. Should I choose not to purchase such a policy, I accept all responsibility for declining to secure coverage."/> <field type="checkbox-group" required="true" label="Travel Insurance Acknowledgement" name="travel-insurance-acknowledgement"> <option label="I Agree" value="i-agree">I Agree</option> </field> </fields> </form-template> </body> </html>
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