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Nicole Conley
Reprise Travel
<html> <body> <form-template> <fields> <field type="text" required="true" label="First name" name="first-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" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Let's find the best cruise for YOU!"/> <field type="radio-group" label="Is this your first cruise?" name="is-this-your-first-cruise"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="I'm a cruise PRO!" value="im-a-cruise-pro">I'm a cruise PRO!</option> </field> <field type="checkbox-group" label="The purpose of this cruise vacation is:" name="the-purpose-of-this-cruise-vacation-is"> <option label="Making Memories w/ Family and/or friends" value="making-memories-w-family-andor-friends">Making Memories w/ Family and/or friends</option> <option label="Romance" value="romance">Romance</option> <option label="Just For Fun!" value="just-for-fun">Just For Fun!</option> <option label="Relax & Recharge (Spa?)" value="relax-recharge-spa">Relax & Recharge (Spa?)</option> <option label="Celebrating a Special Occasion" value="celebrating-a-special-occasion">Celebrating a Special Occasion</option> </field> <field type="text" label="Where would you like to go? It can be a description like "tropical" or if there's a certain port you must visit, please share it here." placeholder="ex: Tahiti" name="preferred-destinations" subtype="text" className="form-control"/> <field type="text" label="Is there anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/> <field type="text" label="Are there any ports you would prefer to avoid?&nbsp;" name="are-there-any-ports-you-want-to-avoid" subtype="text" className="form-control"/> <field type="text" label="Which ports you can depart from?" name="ports-you-can-depart-from" subtype="text" className="form-control"/> <field type="text" label="Which cruise lines have you sailed with before?" name="cruise-lines-youve-sailed-before" subtype="text" className="form-control"/> <field type="text" label="Which ones are on your wishlist?" name="which-ones-are-on-your-wishlist" subtype="text" className="form-control"/> <field type="text" label="Would you call yourself a foodie? What type of food excites you?" name="would-you-call-yourself-a-foodie-what-type-of-food-excites-you" subtype="text" className="form-control"/> <field type="radio-group" label="Are you looking forward to:" description="Choose as many as you like" name="are-you-looking-forward-to"> <option label="The buffet" value="the-buffet">The buffet</option> <option label="The main dining room" value="the-main-dining-room">The main dining room</option> <option label="Specialty restaurants all the way!" value="specialty-restaurants-all-the-way">Specialty restaurants all the way!</option> </field> <field type="checkbox-group" label="Are any of these important?" inline="true" name="are-any-of-these-important" other="true"> <option label="Casino" value="casino">Casino</option> <option label="Babysitting" value="babysitting">Babysitting</option> <option label="Kids/Teen Club" value="kidsteen-club">Kids/Teen Club</option> <option label="Sports court" value="sports-court">Sports court</option> <option label="Lots of specialty dining venues" value="lots-of-specialty-dining-venues">Lots of specialty dining venues</option> <option label="Rock wall" value="rock-wall">Rock wall</option> <option label="Zipline" value="zipline">Zipline</option> <option label="Flow Rider" value="flow-rider">Flow Rider</option> <option label="Water slide" value="water-slide">Water slide</option> <option label="Go-carts" value="gocarts">Go-carts</option> <option label="Adults-only pool" value="adultsonly-pool">Adults-only pool</option> <option label="Outdoor movies" value="outdoor-movies">Outdoor movies</option> <option label="Spa" value="spa">Spa</option> <option label="Nightly shows" value="nightly-shows">Nightly shows</option> </field> <field type="checkbox-group" 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" 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="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theater" value="art-theater">Arts and theater</option> <option label="Golf" value="golf">Golf</option> </field> <field type="checkbox-group" label="What type of cabin are you interested in?&nbsp;" name="what-type-of-cabin-are-you-interested-in-" other="true"> <option label="We're splurging on a suite because we deserve it!" value="were-splurging-on-a-suite-because-we-deserve-it">We're splurging on a suite because we deserve it!</option> <option label="We'd like to have a balcony where we can enjoy morning coffee in the fresh, sea air" value="wed-like-to-have-a-balcony-where-we-can-enjoy-morning-coffee-in-the-fresh-sea-air">We'd like to have a balcony where we can enjoy morning coffee in the fresh, sea air</option> <option label="As long as we have a window to look out of, we're happy" value="as-long-as-we-have-a-window-to-look-out-of-were-happy">As long as we have a window to look out of, we're happy</option> <option label="An interior cabin is where we get the best sleep" value="an-interior-cabin-is-where-we-get-the-best-sleep">An interior cabin is where we get the best sleep</option> <option label="Tell me about some of the unique cabin options that are available" value="tell-me-about-some-of-the-unique-cabin-options-that-are-available">Tell me about some of the unique cabin options that are available</option> </field> <field type="radio-group" label="What best describes your hotel/cruise preference?" name="hotel-preference" other="true"> <option label="Value" value="value">Value</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="text" required="true" label="What is the price range you are comfortable with? Please specify if it is per person or total." name="what-is-the-price-range-you-are-comfortable-with-please-specify-if-it-is-per-person-or-total" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Practical Information"/> <field type="date" label="Earliest you can 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" label="Latest you can 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" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> </field> <field type="text" label="How many nights would you like the cruise to be (can be a range)?" name="how-many-nights-would-you-like-the-cruise-to-be-can-be-a-range" subtype="text" className="form-control"/> <field type="textarea" label="Number of cabins and location preferences - Do they need to connect, or is side-by-side or just nearby ok?" name="number-of-cabins-and-location-preferences" className="form-control"/> <field type="textarea" label="Number of travelers and their ages?" name="number-of-travelers-and-their-ages" className="form-control"/> <field type="radio-group" required="true" label="Is anyone in your party pregnant or planning to become pregnant before the cruise?&nbsp;" description="So that we can advise as each cruise line has its own pregnancy policy. All information is private." name="is-anyone-in-your-party-pregnant-or-planning-to-become-pregnant-before-the-cruise-" other="true"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="textarea" label="Are there any medical or dietary needs/preferences ? Does anyone in your party have mobility issues I should be aware of?" name="what-else-would-you-like-me-to-know-do-you-have-any-medical-or-dietary-needspreferences-does-anyone-in-your-party-have-mobility-issues-i-should-be-aware-of" className="form-control"/> <field type="radio-group" required="true" label="Is everyone in your party a US citizen?" description="If not we need to know so that we can advise you properly" name="is-everyone-in-your-party-a-us-citizen" other="true"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" label="Promotions you qualify for (if available):" name="promotions-you-qualify-for-if-available" other="true"> <option label="Senior (55 or older)" value="senior-55-or-older">Senior (55 or older)</option> <option label="Military" value="military">Military</option> <option label="Fire/EMT/Law Enforcement" value="fireemtlaw-enforcement">Fire/EMT/Law Enforcement</option> <option label="Teacher" value="teacher">Teacher</option> </field> <field type="text" label="What state do you live in?" name="what-state-do-you-live-in" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="By proceeding with travel arrangements, I acknowledge that certain destinations, tour companies, and cruise lines may require COVID-19 vaccination, and it is my responsibility to ascertain and comply with these requirements." name="by-proceeding-with-travel-arrangements-i-acknowledge-that-certain-destinations-tour-companies-and-cruise-lines-may-require-covid19-vaccination-and-it-is-my-responsibility-to-ascertain-and-comply-with-these-requirements"> <option label="I acknowledge" value="i-acknowledge">I acknowledge</option> </field> <field type="radio-group" required="true" label="I understand that it is vitally important that I read the information emailed to me by my advisor in order to be prepared for travel in the current climate. I also understand that I share the responsibility of remaining informed about the entry requirements for the destination(s) I am visiting. I will secure all necessary testing and complete all forms required for travel." name="i-understand-that-it-is-vitally-important-that-i-read-the-information-emailed-to-me-by-my-advisor-in-order-to-be-prepared-for-travel-in-the-current-climate-i-also-understand-that-i-share-the-responsibility-of-remaining-informed-about-the-entry-requirements-for-the-destinations-i-am-visiting-i-will-secure-all-necessary-testing-and-complete-all-forms-required-for-travel"> <option label="I agree" value="i-agree">I agree</option> <option label="I do not agree" value="i-do-not-agree">I do not agree</option> </field> </fields> </form-template> </body> </html>
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