Share your information with Teressa Short

Teressa Short

The Luxe Travel Circle

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Primary Travelers Full Name"/>&#13;
		<field type="text" required="true" 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 type="header" subtype="h2" label="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" 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" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of Event" name="date-of-event" className="form-control"/>&#13;
		<field type="date" label="Hotel Check In Date" description="Skip if hotel is not needed" name="check-in-date" className="form-control"/>&#13;
		<field type="date" label="Hotel Check Out Date" description="Skip if hotel is not needed" name="check-out-date" className="form-control"/>&#13;
		<field type="text" required="true" label="Total number of travelers" name="total-number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Total number of Rooms Needed" name="text-1742244644715" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Rooming Preferences (Shared or Single Occupancy)" description="Will all travelers be double occupancy or will have you any single room occupancy travelers? For example if you have 12 Travelers at double occupancy that would be 6 rooms needed. or 12 people with 10 double occupancy and 2 single so 7 rooms would be needed." name="rooming-preferences-shared-or-single-occupancy" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Budget (Per Person)" description="Please be as accurate as possible here. If the budget is flexible you can enter a range. For Example $2500-$3000 Per Person." name="budget-per-person" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Are there any children from the total # from above?&amp;nbsp;" description="Please list number of children and their ages." name="are-there-any-children-from-the-total-from-above-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Are there any special requests?&amp;nbsp;" description="(Accesibility  Dietary needs etc)" name="are-there-any-special-requests-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Are you celebrating anything?" description="Birthday  Anniversary etc." name="are-you-celebrating-anything" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Seating" name="seating">&#13;
			<option label="Inexpensive (Upper Level)" value="inexpensive-upper-level">Inexpensive (Upper Level)</option>&#13;
			<option label="Average/Good (Mid Level)" value="averagegood-mid-level">Average/Good (Mid Level)</option>&#13;
			<option label="Premium/Club Level" value="premiumclub-level">Premium/Club Level</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Flights are not included in the sports package however transportation to/from the airport is included if you are flying in. Will you need round trip airport transportation?" name="flights-are-not-included-in-the-sports-package-however-transportation-tofrom-the-airport-is-included-if-you-are-flying-in-will-you-need-round-trip-airport-transportation" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no" selected="selected">No</option>&#13;
		</field>&#13;
		<field type="text" label="Is there anything else that I need to know?" description="If you selected &quot;Other&quot; on What are you looking to book  please provide that information here." name="is-there-anything-else-that-i-need-to-know" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>