Share your information with Rekyiah Clifton

Rekyiah Clifton

Travel With Rekyiah

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions For Your Cruise"/>&#13;
		<field type="date" 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"/>&#13;
		<field type="date" 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"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your cruise fare budget for per traveler?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$500 to $1,000" value="500-to-1000">$500 to $1,000</option>&#13;
			<option label="$1,000 to $2,000" value="1000-to-2000">$1,000 to $2,000</option>&#13;
			<option label="$2,000 to $3,000" value="2000-to-3000">$2,000 to $3,000</option>&#13;
			<option label="$3,000 to $4,000" value="3000-to-4000">$3,000 to $4,000</option>&#13;
			<option label="$4,000 to $5,000" value="4000-to-5000">$4,000 to $5,000</option>&#13;
			<option label="$5,000+" value="5000">$5,000+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What cruiseline(s) are you interested in?" name="what-cruiselines-are-you-interested-in" other="true">&#13;
			<option label="Carnival" value="carnival">Carnival</option>&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option>&#13;
			<option label="Celebrity" value="celebrity">Celebrity</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What is your cabin preference?" name="what-is-your-cabin-preference">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic/Anniversary" value="romanticanniversary">Romantic/Anniversary</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Adult Only" value="adult-only">Adult Only</option>&#13;
		</field>&#13;
		<field type="text" label="Where would you like to go?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="text" label="*If you already have determined what cruise itinerary you would like to go on, please provide the ship name, departure port, and departure date here.&amp;nbsp;" name="text-1738701889268" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know? Please include any special accommodations here.&amp;nbsp;" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" required="true" label="Prefix" description="Mr/Ms/Mrs/Etc" 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="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country" name="address-country" 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="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<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"/>&#13;
		<field type="checkbox-group" required="true" label="Are you a US citizen?" name="are-you-a-us-citizen">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>