Share your information with Domica Thomas

Domica Thomas

Rosy Memories Travel

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" 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="h1" label="Vacation Details"/>&#13;
		<field type="text" required="true" label="Destination" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Travel Dates" name="travel-dates" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of Travelers: # of Adults&amp;nbsp; # Children (specify age of children)" name="number-of-travelers-of-adults-children-specify-age-of-children" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Interests and Preferences"/>&#13;
		<field type="checkbox-group" required="true" label="What types of activities are you interested in? (Select all that apply)" inline="true" name="what-types-of-activities-are-you-interested-in-select-all-that-apply">&#13;
			<option label="Adventure (ziplining, hiking, etc)" value="Adventure (ziplining, hiking, etc)">Adventure (ziplining, hiking, etc)</option>&#13;
			<option label="Relaxation (spa, beach)" value="Relaxation (spa, beach)">Relaxation (spa, beach)</option>&#13;
			<option label="Cultural (museums, local tours)" value="Cultural (museums, local tours)">Cultural (museums, local tours)</option>&#13;
			<option label="Family-friendly (theme parks, zoos)" value="Family-friendly (theme parks, zoos)">Family-friendly (theme parks, zoos)</option>&#13;
			<option label="Water-based (snorkeling, boating)" value="Water-based (snorkeling, boating)">Water-based (snorkeling, boating)</option>&#13;
			<option label="Food and Wine (cooking, classes, wine tours)" value="Food and Wine (cooking, classes, wine tours)">Food and Wine (cooking, classes, wine tours)</option>&#13;
			<option label="Entertainment (shows, concerts)" value="Entertainment (shows, concerts)">Entertainment (shows, concerts)</option>&#13;
			<option label="Shopping" value="Shopping">Shopping</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Activity Intensity Level: (Choose One)" name="activity-intensity-level-choose-one" className="form-control">&#13;
			<option label="Low (Relaxed, easygoing)" value="Low (Relaxed, easygoing)">Low (Relaxed, easygoing)</option>&#13;
			<option label="Medium (Moderate, some physical activity)" value="Medium (Moderate, some physical activity)">Medium (Moderate, some physical activity)</option>&#13;
			<option label="High (Active, adventurous)" value="High (Active, adventurous)">High (Active, adventurous)</option>&#13;
		</field>&#13;
		<field type="text" label="Are there any specific activities or attractions you&#39;d like to include?" name="are-there-any-specific-activities-or-attractions-youd-like-to-include" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Any activities or experiences you want to avoid?" name="any-activities-or-experiences-you-want-to-avoid" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Special Considerations"/>&#13;
		<field type="text" label="Are there any dietary restrictions or preferences?" name="are-there-any-dietary-restrictions-or-preferences" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Are there any physical limitations or accessibility needs?" name="are-there-any-physical-limitations-or-accessibility-needs" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Are you celebrating any special occasion? (e.g., anniversary, birthday)" name="are-you-celebrating-any-special-occasion-eg-anniversary-birthday" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Budget and Timing"/>&#13;
		<field type="select" required="true" label="What is your estimated budget for activities per person?" name="what-is-your-estimated-budget-for-activities-per-person" className="form-control">&#13;
			<option label="$50-$100" value="$50-$100">$50-$100</option>&#13;
			<option label="$100-$200" value="$100-$200">$100-$200</option>&#13;
			<option label="$200-$500" value="$200-$500">$200-$500</option>&#13;
			<option label="$500+" value="$500+">$500+</option>&#13;
		</field>&#13;
		<field type="select" label="Do you prefer activities to be: (Choose one)" name="do-you-prefer-activities-to-be-choose-one" className="form-control">&#13;
			<option label="Pre-scheduled (set-times)" value="Prescheduled (set-times)">Pre-scheduled (set-times)</option>&#13;
			<option label="Flexible (can decide on the day)" value="Flexible (can decide on the day)">Flexible (can decide on the day)</option>&#13;
		</field>&#13;
		<field type="text" label="Is there anything else we should know to help plan your perfect vacation?" name="is-there-anything-else-we-should-know-to-help-plan-your-perfect-vacation" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>