<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Thank you for reaching out!"/> <field type="text" required="true" label="Who referred you to Aga Travel?" description="Please enter name if friend or family member" placeholder="If friend/family please enter name" name="where-did-you-hear-about-aga-travel" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Vaccination Status"/> <field type="radio-group" required="true" label="Please share your vaccination status so that I may advise you properly on the COVID requirements for your trip." description="If you choose "Other " please share explanation in the notes box." name="please-share-your-vaccination-status-so-that-i-may-advise-you-properly-on-the-covid-requirements-for-your-trip"> <option label="Everyone in my party is fully vaccinated" value="everyone-in-my-party-is-fully-vaccinated">Everyone in my party is fully vaccinated</option> <option label="Nobody in my party is fully vaccinated" value="nobody-in-my-party-is-fully-vaccinated">Nobody in my party is fully vaccinated</option> <option label="Some are and some are not fully vaccinated" value="some-are-and-some-are-not-fully-vaccinated">Some are and some are not fully vaccinated</option> <option label="Other" value="other">Other</option> </field> <field type="text" label="Notes that you would like to share regarding vaccination status:" name="notes-that-you-would-like-to-share-regarding-vaccination-status" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Questions About the Trip"/> <field type="radio-group" label="The goal for this vacation is:" name="the-goal-for-this-vacation-is" other="true"> <option label="Romance" value="romance">Romance</option> <option label="Making Memories with Family" value="making-memories-with-family">Making Memories with Family</option> <option label="Just a Fun Getaway (Activities)" value="just-a-fun-getaway-activities">Just a Fun Getaway (Activities)</option> <option label="Relax & Recharge (Spa)" value="relax-recharge-spa">Relax & Recharge (Spa)</option> <option label="Celebrating Special Occasion" value="celebrating-special-occasion">Celebrating Special Occasion</option> </field> <field type="textarea" required="true" label="Tell me a little bit about what you are picturing for this vacation:" description="Please enter any information that will help me plan your trip your ideal trip vision, any important details you can think of..." name="additional-comments" className="form-control"/> <field type="date" required="true" label="Earliest date you can depart?" description="This give us a starting point we can always change later." name="earliest-date-you-can-depart" className="form-control"/> <field type="date" required="true" label="Latest date you can return?" description="This give us a starting point we can always change later." name="latest-date-you-can-return" className="form-control"/> <field type="checkbox-group" required="true" label="Are your dates flexible?" inline="true" name="are-your-dates-flexible" other="true"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" required="true" label="What is the price range you are comfortable with?" description="Please give me an idea about YOUR budget for this particular trip. Like buying a car there is a wide range of offers, but not every offer is the right one for all people. My job is to find the best vacation fitting your needs." placeholder="Please specify amount and if it is per person or total for your party." name="what-is-the-price-range-you-are-comfortable-with" subtype="text" className="form-control"/> <field type="text" label="Any additional notes about the price range?&nbsp;" name="any-additional-notes-about-the-price-range-" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Personal Information - all names must match passports (unless planning domestic trip)"/> <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="Preferred name (nickname)" name="preferred-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Primary cell phone number" name="phone-number" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Important Dates"/> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="date" label="Wedding Date (if planning honeymoon, or interested in future anniversary trips)" name="wedding-anniversary" className="form-control"/> <field type="radio-group" required="true" label="Gender" inline="true" name="radio-group-1639361987448"> <option label="M" value="m">M</option> <option label="F" value="f">F</option> </field> <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" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" 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="text" label="Country" name="address-country" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Passport Info"/> <field type="radio-group" required="true" label="Do you have a valid passport?" inline="true" name="do-you-have-a-valid-passport"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="Passport Issuing Country / Citizenship" name="passport-issuing-country-citizenship" subtype="text" className="form-control"/> <field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/> <field type="header" subtype="h2" label="Loyalty Programs"/> <field type="paragraph" subtype="p" label="I work with many wholesalers who offer package prices, which are great because you will usually pay significantly less than booking the accommodations, flights, and transportation separately. The payment schedules are often more flexible as well. It is important to note that the rules can be different for these contracted rates so if you have status with an airline or hotel brand and/or are looking to accrue points, I need to know so that we can discuss your priorities."/> <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="header" subtype="h2" label="Travel Companions - all names must match passports (unless planning domestic trip)"/> <field type="header" subtype="h1" label="Companion #1"/> <field type="textarea" label="Companion #1 - Contact Info" description="If Companion #1 is an adult please enter that person's email and cell phone. It is important I have this additional information if I need to urgently contact you after the booking." placeholder="If Companion #1 is an adult please enter that person's email and cell phone" name="companion-1-contact-info" className="form-control"/> <field type="text" label="Companion #1 First Name" name="companion-1-full-name" subtype="text" className="form-control"/> <field type="text" label="Companion #1 Middle Name" name="companion-1-middle-name" subtype="text" className="form-control"/> <field type="text" label="Companion #1 Last Name" name="companion-1-last-name" subtype="text" className="form-control"/> <field type="date" label="Companion #1 Date of Birth" name="companion-1-date-of-birth" className="form-control"/> <field type="radio-group" label="Companion #1 Gender" inline="true" name="companion-1-gender"> <option label="M" value="m">M</option> <option label="F" value="f">F</option> </field> <field type="radio-group" label="Valid Passport for Companion #1?" inline="true" name="valid-passport-for-companion-1"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="Companion #1 - Passport Issuing Country / Citizenship" name="companion-1-passport-issuing-country-citizenship" subtype="text" className="form-control"/> <field type="date" label="Companion #1 Passport Expiration Date" name="companion-1-passport-expiration-date" className="form-control"/> <field type="header" subtype="h1" label="Companion #2"/> <field type="text" label="Companion #2 First Name" name="companion-2-full-name" subtype="text" className="form-control"/> <field type="text" label="Companion #2 Middle Name" name="companion-2-middle-name" subtype="text" className="form-control"/> <field type="text" label="Companion #2 Last Name" name="companion-2-last-name" subtype="text" className="form-control"/> <field type="date" label="Companion #2 Date of Birth" name="companion-2-date-of-birth" className="form-control"/> <field type="radio-group" label="Companion #2 Gender" inline="true" name="companion-2-gender"> <option label="M" value="m">M</option> <option label="F" value="f">F</option> </field> <field type="text" label="Companion #2 - Passport Issuing Country / Citizenship" name="companion-2-passport-issuing-country-citizenship" subtype="text" className="form-control"/> <field type="radio-group" label="Valid Passport for Companion #2?" inline="true" name="valid-passport-for-companion-2"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="date" label="Companion #2 Passport Expiration Date" name="companion-2-passport-expiration-date" className="form-control"/> <field type="header" subtype="h1" label="Companion #3"/> <field type="text" label="Companion #3 First Name" name="companion-3-full-name" subtype="text" className="form-control"/> <field type="text" label="Companion #3 Middle Name" name="companion-3-middle-name" subtype="text" className="form-control"/> <field type="text" label="Companion #3 Last Name" name="companion-3-last-name" subtype="text" className="form-control"/> <field type="date" label="Companion #3 Date of Birth" name="companion-3-date-of-birth" className="form-control"/> <field type="radio-group" label="Companion #3 Gender" inline="true" name="companion-3-gender"> <option label="M" value="m">M</option> <option label="F" value="f">F</option> </field> <field type="text" label="Companion #3 - Passport Issuing Country / Citizenship" name="companion-3-passport-issuing-country-citizenship" subtype="text" className="form-control"/> <field type="radio-group" label="Valid Passport for Companion #3?" inline="true" name="valid-passport-for-companion-3"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="date" label="Companion #3 Passport Expiration Date" name="companion-3-passport-expiration-date" className="form-control"/> <field type="header" subtype="h1" label="Companion #4"/> <field type="text" label="Companion #4 First Name" name="companion-4-full-name" subtype="text" className="form-control"/> <field type="text" label="Companion #4 Middle Name" name="companion-4-middle-name" subtype="text" className="form-control"/> <field type="text" label="Companion #4 Last Name" name="companion-4-last-name" subtype="text" className="form-control"/> <field type="date" label="Companion #4 Date of Birth" name="companion-4-date-of-birth" className="form-control"/> <field type="radio-group" label="Companion #4 Gender" inline="true" name="companion-4-gender"> <option label="M" value="m">M</option> <option label="F" value="f">F</option> </field> <field type="text" label="Companion #4 - Passport Issuing Country / Citizenship" name="companion-4-passport-issuing-country-citizenship" subtype="text" className="form-control"/> <field type="radio-group" label="Valid Passport for Companion #4?" inline="true" name="valid-passport-for-companion-4"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="date" label="Companion #4 Passport Expiration Date" name="companion-4-passport-expiration-date" className="form-control"/> <field type="header" subtype="h1" label="Thank you for providing the details that will help me plan your custom trip plan!"/> <field type="textarea" label="Final check, anything else you would like me to know?" description="Preferred hotel brand or one to avoid; medical, mobility, or dietary needs, etc." name="what-else-would-you-like-me-to-know" className="form-control"/> </fields> </form-template> </body> </html>
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