Share your information with Harley Petrin

Harley Petrin

Travelmation

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>&#13;
		<field type="header" subtype="h2" label="Vacation Request Form"/>&#13;
		<field type="paragraph" subtype="p" label="Please fill out the information below and send the form back to me. As part of my organization goal I am aiming to stay up to date with client information.  Please note - your response will come to my inbox, if you do not hear from me in 72 hours please send me a text or email letting me know you completed my vacation request form.&amp;nbsp;&amp;nbsp;   Please verify all information before you send the form back.  Thank you."/>&#13;
		<field type="text" required="true" label="First &amp;amp; Last Name" placeholder="Your answer" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone Number" placeholder="Your answer" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" placeholder="Your answer" name="email" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What type of destination are you looking for&amp;nbsp;" name="textarea-1775951723098" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What are your planned travel dates?" name="textarea-1775950299109" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Do you have any dietary restrictions, health considerations, or accessibility needs?" name="textarea-1775951603528" className="form-control"/>&#13;
		<field type="textarea" required="true" label="How many travelers (adults/children) are in your group, and what are their ages?" name="textarea-1775951253938" className="form-control"/>&#13;
		<field type="textarea" label="What is your approximate total budget for this trip (including flights, lodging, and activities)?" name="textarea-1775950343821" className="form-control"/>&#13;
		<field type="textarea" label="Are you celebrating a special occasion?" name="textarea-1775951501004" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How did you hear about me?" name="how-did-you-hear-about-me" other="true" className="radio-group">&#13;
			<option label="Family &amp; Friends / Word of Mouth" value="Family &amp; Friends / Word of Mouth">Family &amp; Friends / Word of Mouth</option>&#13;
			<option label="Internet Search" value="Internet Search">Internet Search</option>&#13;
			<option label="Festival" value="Festival">Festival</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>