Share your information with Explore Blue Travel

Explore Blue Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Travel With Ease"/>&#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="radio-group" required="true" label="What type of assistance are you interested in?" name="radio-group-1785586335231">&#13;
			<option label="Personalized trip planning" value="personalized-trip-planning">Personalized trip planning</option>&#13;
			<option label="Planning a group trip for your own travelers" value="planning-a-group-trip-for-your-own-travelers">Planning a group trip for your own travelers</option>&#13;
			<option label="Joining an Explore Blue Travel hosted trip" value="joining-an-explore-blue-travel-hosted-trip">Joining an Explore Blue Travel hosted trip</option>&#13;
			<option label="Business or corporate retreat planning" value="business-or-corporate-retreat-planning">Business or corporate retreat planning</option>&#13;
			<option label="I am not sure yet" value="i-am-not-sure-yet">I am not sure yet</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="When are you hoping to travel?" name="select-1785586467428" className="form-control">&#13;
			<option label="I already have exact travel dates" value="i-already-have-exact-travel-dates">I already have exact travel dates</option>&#13;
			<option label="Within the next 30 days" value="within-the-next-30-days">Within the next 30 days</option>&#13;
			<option label="Within 1 to 3 months" value="within-1-to-3-months">Within 1 to 3 months</option>&#13;
			<option label="Within 4 to 6 months" value="within-4-to-6-months">Within 4 to 6 months</option>&#13;
			<option label="Within 7 to 12 months" value="within-7-to-12-months">Within 7 to 12 months</option>&#13;
			<option label="More than 12 months from now" value="more-than-12-months-from-now">More than 12 months from now</option>&#13;
			<option label="I am flexible and need help choosing dates" value="i-am-flexible-and-need-help-choosing-dates">I am flexible and need help choosing dates</option>&#13;
			<option label="I am only exploring right now" value="i-am-only-exploring-right-now">I am only exploring right now</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many travelers are you planning for?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What destination are you considering?" 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="radio-group" required="true" label="What is your budget per traveler?" description="This just gives me a general starting point and can always be changed later." name="budget">&#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="text" required="true" label="Are you ready to begin the planning process within the next 14 days?" name="text-1785586754552" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Are you aware that trip planning requires a nonrefundable professional planning fee?" name="text-1785586823159" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What is the best way to contact you?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>