<html> <body> <form-template> <fields> <field type="header" subtype="h2" 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" required="true" 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="radio-group" required="true" label="Gender" name="gender-primary"> <option label="Female" value="female">Female</option> <option label="Male" value="male">Male</option> </field> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="header" subtype="h2" label="Travel Documents&nbsp;"/> <field type="radio-group" required="true" label="Passport Holder" description="A copy of the information page will be requested via email" name="gender"> <option label="Y" value="YES">Y</option> <option label="N" value="NO">N</option> </field> <field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/> <field type="checkbox-group" required="true" label="REAL ID" description="Domestic Flights After May 7 2025 requires a REAL ID or Passport" name="real-id"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h2" label="Full Name 2nd Passenger"/> <field type="text" label="Prefix 2nd Passenger&nbsp;" name="prefix-2nd-passenger-" subtype="text" className="form-control"/> <field type="text" required="true" label="First Name 2nd Passenger&nbsp;" name="first-name-2nd-passenger-" subtype="text" className="form-control"/> <field type="text" label="Middle Name 2nd Passenger&nbsp;" name="middle-name-2nd-passenger-" subtype="text" className="form-control"/> <field type="text" required="true" label="Last Name 2nd Passenger" name="last-name-2nd-passenger" subtype="text" className="form-control"/> <field type="text" label="Suffix 2nd Passenger" name="suffix-2nd-passenger" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Gender 2nd Passenger" name="gender-2nd-passenger"> <option label="Female" value="female">Female</option> <option label="Male" value="male">Male</option> </field> <field type="text" required="true" label="Email 2nd Passenger" name="email-2nd-passenger" subtype="text" className="form-control"/> <field type="date" required="true" label="Birthday 2nd Passenger&nbsp;" name="birthday-2nd-passenger-" className="form-control"/> <field type="header" subtype="h2" label="Travel Documents"/> <field type="checkbox-group" required="true" label="Passport Holder 2nd Passenger&nbsp;" name="passport-holder-2nd-passenger-"> <option label="Y" value="Y">Y</option> <option label="N" value="N">N</option> </field> <field type="date" label="Date of Expiration 2nd Passenger" name="date-of-expiration-2nd-passenger" className="form-control"/> <field type="checkbox-group" required="true" label="REAL ID 2nd Passenger" name="real-id-2nd-passenger"> <option label="Y" value="Y">Y</option> <option label="N" value="N">N</option> </field> <field type="header" subtype="h2" label="Trip Goals"/> <field type="checkbox-group" required="true" label="Have you used a travel agent before?" name="have-you-used-a-travel-agent-before"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" required="true" label="What are your goals for the trip?" name="what-are-your-goals-for-the-trip" subtype="text" className="form-control"/> <field type="checkbox-group" label="Are you celebrating a special occasion?" name="are-you-celebrating-a-special-occasion"> <option label="Birthday" value="birthday">Birthday</option> <option label="Honeymoon" value="honeymoon">Honeymoon</option> <option label="Anniversary/Vow Renewal" value="anniversaryvow-renewal">Anniversary/Vow Renewal</option> <option label="Graduation" value="graduation">Graduation</option> <option label="Baecation" value="baecation">Baecation</option> <option label="Bachelor/Bachelorette Trip" value="bachelorbachelorette-trip">Bachelor/Bachelorette Trip</option> <option label="Other" value="other">Other</option> </field> <field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Travel Details"/> <field type="text" required="true" label="Where would you like to go?" placeholder="Provide one destination ONLY additional locations require non-refundable research fee" name="destination" subtype="text" className="form-control"/> <field type="date" required="true" label="When would you like to depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/> <field type="date" required="true" label="When would you like to return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/> <field type="checkbox-group" required="true" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" required="true" label="How many nights would you like to stay?" name="how-many-nights-would-you-like-to-stay" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Flights" description="For group travel over 10 it is recommended for passengers to book flights separately" name="flights"> <option label="Roundtrip" value="roundtrip">Roundtrip</option> <option label="One-way" value="oneway">One-way</option> <option label="No flights. Land only" value="no-flights-land-only">No flights. Land only</option> </field> <field type="text" required="true" label="What is your departure city?" description="Where will you be flying from? Type N/A if no flight needed" name="departure-city" subtype="text" className="form-control"/> <field type="textarea" label="Is the departure city the same for all travelers?&nbsp;" name="is-the-departure-city-the-same-for-all-travelers-" className="form-control"/> <field type="radio-group" required="true" label="Would you like travel protection included in your package?" name="would-you-like-travel-protection-included-in-your-package"> <option label="Yes - Cancel for covered reasons before departure and receive a future travel credit" value="yes-cancel-for-covered-reasons-before-departure-and-receive-a-future-travel-credit">Yes - Cancel for covered reasons before departure and receive a future travel credit</option> <option label="Yes - Cancel for covered reason and receive a refund to the original form of payment " value="yes-cancel-for-covered-reason-and-receive-a-refund-to-the-original-form-of-payment-">Yes - Cancel for covered reason and receive a refund to the original form of payment </option> <option label="No - I agree to sign a waiver of travel protection coverage" value="no-i-agree-to-sign-a-waiver-of-travel-protection-coverage">No - I agree to sign a waiver of travel protection coverage</option> </field> <field type="radio-group" required="true" label="Shared roundtrip transfers are included in most packages, would you like them to remain?" name="shared-roundtrip-transfers-are-included-in-most-packages-would-you-like-them-to-remain"> <option label="Yes, include shared roundtrip transfers" value="yes-include-shared-roundtrip-transfers">Yes, include shared roundtrip transfers</option> <option label="No, change to private roundtrip transfers" value="no-change-to-private-roundtrip-transfers">No, change to private roundtrip transfers</option> <option label="No, change to luxury roundtrip transfers" value="no-change-to-luxury-roundtrip-transfers">No, change to luxury roundtrip transfers</option> <option label="No, do not include transfers" value="no-do-not-include-transfers">No, do not include transfers</option> </field> <field type="text" required="true" label="Number of adult travelers?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="text" required="true" label="Number of rooms needed" name="number-of-rooms-needed" subtype="text" className="form-control"/> <field type="textarea" required="true" label="Number of minors traveling?" name="does-this-include-children-if-so-how-many" className="form-control"/> <field type="textarea" required="true" label="Please provide additional travelers information here" description="If none input N/A. Please include First Last Name and DOB" name="please-provide-additional-travelers-information-here" className="form-control"/> <field type="header" subtype="h2" label="Travel Preferences"/> <field type="radio-group" required="true" label="What is your total budget? (Based on two people)" description="This just gives me a general starting point and can always be changed later." name="budget"> <option label="$950 to $1,000" value="950-to-1000">$950 to $1,000</option> <option label="$1,000 to $1,500" value="1000-1500">$1,000 to $1,500</option> <option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option> <option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option> <option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option> <option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option> <option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option> <option label="$10,000+" value="10000">$10,000+</option> </field> <field type="radio-group" required="true" label="What best describes your hotel preference?" name="hotel-preference" other="true"> <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" required="true" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true"> <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> </field> <field type="checkbox-group" required="true" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true"> <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 theater" value="art-theater">Arts and theater</option> </field> <field type="radio-group" required="true" label="Would you like all-inclusive accommodations" description="For Mexico and Caribbean place N/A for other locations US does not offer all-inclusive" name="would-you-like-allinclusive-accommodations"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="No preference" value="no-preference">No preference</option> <option label="N/A" value="na">N/A</option> </field> <field type="radio-group" required="true" label="Do you prefer adult-only resorts or family friendly?" name="do-you-prefer-adultonly-resorts-or-family-friendly"> <option label="Adult-Only" value="adultonly">Adult-Only</option> <option label="Family Friendly" value="family-friendly">Family Friendly</option> <option label="No preference" value="no-preference">No preference</option> </field> <field type="text" required="true" label="Do you already have a hotel/resort you'd like for your trip? If so what is it?" name="do-you-already-have-a-hotelresort-youd-like-for-your-trip-if-so-what-is-it" subtype="text" className="form-control"/> <field type="text" label="If not, please list any amenities that you must have." name="if-not-please-list-any-amenities-that-you-must-have" subtype="text" className="form-control"/> <field type="textarea" label="Please share any additional information I should know." name="notes" className="form-control"/> <field type="checkbox-group" required="true" label="How did you hear about Rosy Memories Travel by Domica&nbsp;" name="how-did-you-hear-about-rosy-memories-travel-by-domica-"> <option label="Social Media" value="social-media">Social Media</option> <option label="Travel Leaders Link" value="travel-leaders-link">Travel Leaders Link</option> <option label="Search Engine" value="search-engine">Search Engine</option> <option label="Referral " value="referral-">Referral </option> <option label="Other" value="other">Other</option> </field> <field type="text" label="If referred by a client of Rosy Memories Travel, please enter their name below:" name="if-referred-by-a-client-of-rosy-memories-travel-please-enter-their-name-below" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Would you like to be added to our email list to receive travel promos and deals?" name="would-you-like-to-be-added-to-our-email-list-to-receive-travel-promos-and-deals"> <option label="Yes, sign me up!" value="yes-sign-me-up">Yes, sign me up!</option> <option label="No, not at this time." value="no-not-at-this-time">No, not at this time.</option> </field> <field type="checkbox-group" required="true" label="Consent" name="consent"> <option label="I consent to having Rosy Memories Travel collect my details via this form." value="i-consent-to-having-rosy-memories-travel-collect-my-details-via-this-form">I consent to having Rosy Memories Travel collect my details via this form.</option> </field> </fields> </form-template> </body> </html>
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