Share your information with Laura Cruz

Laura Cruz

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  <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="Travel Questionnaire&amp;nbsp;"/>&#13;
		<field type="header" subtype="h1" label="To help us plan your perfect trip, please take a moment to complete this questionnaire"/>&#13;
		<field type="text" required="true" label="First&amp;nbsp; Name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Where would you like to go?" 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="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;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="What is your departure city? Where will you be flying from?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many travelers? (# adults / # children)" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget for this trip?" 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="checkbox-group" label="Way(s) of traveling to your destination ?" description="Check all that apply" name="way-of-traveling-to-your-destination">&#13;
			<option label="Flying" value="flying">Flying</option>&#13;
			<option label="Rental Car" value="rental-car">Rental Car</option>&#13;
			<option label="Train" value="train">Train</option>&#13;
			<option label="Sea Cruise" value="sea-cruise">Sea Cruise</option>&#13;
			<option label="River Cruise " value="river-cruise-">River Cruise </option>&#13;
			<option label="RV Road Trip" value="rv-road-trip">RV Road Trip</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What type of atmosphere are you looking for? Check all that apply" description="Check all that apply" name="what-type-of-atmosphere-are-you-looking-for">&#13;
			<option label="Relaxing Beach Getaway" value="relaxing-beach-getaway">Relaxing Beach Getaway</option>&#13;
			<option label="Just Rest and Relaxation " value="just-rest-and-relaxation-">Just Rest and Relaxation </option>&#13;
			<option label="Outdoor Adventure in Nature" value="outdoor-adventure-in-nature">Outdoor Adventure in Nature</option>&#13;
			<option label="Family Friendly " value="family-friendly-">Family Friendly </option>&#13;
			<option label="Somewhere off the Beaten Path" value="somewhere-off-the-beaten-path">Somewhere off the Beaten Path</option>&#13;
			<option label="Cultural City Experience" value="cultural-city-experience">Cultural City Experience</option>&#13;
			<option label="Historical or Heritage Sites" value="historical-or-heritage-sites">Historical or Heritage Sites</option>&#13;
			<option label="Food &amp; Wine-Focused Destination" value="food-winefocused-destination">Food &amp; Wine-Focused Destination</option>&#13;
			<option label="All Inclusive /Resort" value="all-inclusive-resort">All Inclusive /Resort</option>&#13;
			<option label="Luxury Resort or Cruise" value="luxury-resort-or-cruise">Luxury Resort or Cruise</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What best describes your hotel preferences?" description="Let me know your must haves." name="what-best-describes-your-hotel-preferences" other="true">&#13;
			<option label="5 Star Luxury " value="5-star-luxury-">5 Star Luxury </option>&#13;
			<option label="4 Star Deluxe Comfort " value="4-star-deluxe-comfort-">4 Star Deluxe Comfort </option>&#13;
			<option label="3 Star Good Quality " value="3-star-good-quality-">3 Star Good Quality </option>&#13;
			<option label="2 Star Economy" value="2-star-economy">2 Star Economy</option>&#13;
			<option label="Bare  Necessities" value="bare-necessities">Bare  Necessities</option>&#13;
			<option label="Best Value " value="best-value-">Best Value </option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Are there any other special requests or considerations you would like to mention?" 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="text" label="How did you hear about us or who referred you?" name="how-did-you-hear-about-uswho-referred-you" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>