Share your information with Keisha Roberts

Keisha Roberts

Top Tier Travel

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		<field type="paragraph" subtype="p" label="Let&#39;s plan your next unforgettable getaway.&amp;nbsp; Fill out this quick form so I can understand your travel needs before your 15 minute consultation.&amp;nbsp; Please give me a call at (336)979-6663 at the appointment time you schedule.  If I become unavailable  I will reschedule your session or text you with an update. If you need to cancel, please reschedule at a later date or text me to let me know you need to cancel.&amp;nbsp; Please do not skip this next step because you will have to plan a time and date on my calendar.&amp;nbsp; Click the link https://calendly.com/toptiertravel99/15min or copy in your browser to schedule your free consultation.&amp;nbsp;"/>&#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" 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" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#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="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget for all travelers? (per person)" description="This just gives me a general starting point and can always be changed later." name="what-is-your-budget-for-all-travelers-per-person" className="radio-group">&#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="header" subtype="h1" label="How soon are you ready to book?"/>&#13;
		<field type="radio-group" required="true" label="How soon are you ready to book?" description="How soon are you ready to book?" name="radio-group-1776175211391">&#13;
			<option label="Immediately" value="immediately">Immediately</option>&#13;
			<option label="Within the week" value="within-the-week">Within the week</option>&#13;
			<option label="Within 1-2 weeks" value="within-12-weeks">Within 1-2 weeks</option>&#13;
			<option label="Not sure yet" value="not-sure-yet">Not sure yet</option>&#13;
			<option label="Just Exploring" value="just-exploring">Just Exploring</option>&#13;
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		<field type="header" subtype="h1" label="Are you currently working with a travel advisor?"/>&#13;
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			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Did you set up your complimentary consultation as stated above through this link: https://calendly.com/toptiertravel99/15min" name="radio-group-1781528430109">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
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