Share your information with Ashley Mitchell

Ashley Mitchell

Cure Family Travel

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		<field type="header" subtype="h3" label="Thank you for reaching out! Please fill out the form below if you are ready to start the planning process for your vacation!&amp;nbsp;"/>&#13;
		<field type="paragraph" subtype="p" label="By completing this form you agree that you are not working with another Travel Advisor or Vendor directly."/>&#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" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" 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="How do you like to communicate?" name="radio-group-1767381946953">&#13;
			<option label="Email (check your spam for ashley.curefamilytravel@gmail.com)" value="email-check-your-spam-for-ashleycurefamilytravelgmailcom">Email (check your spam for ashley.curefamilytravel@gmail.com)</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Phone call" value="phone-call">Phone call</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Street" name="address-line-1" 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="pageBreak" name="pageBreak-1768331628323" next="Next" previous="Previous"/>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="radio-group" required="true" label="Are you working with or planning to reach out to other agents?" name="radio-group-1783535532777">&#13;
			<option label="Of course not. I understand that Resorts sets pricing so everyone will have the same pricing" value="of-course-not-i-understand-that-resorts-sets-pricing-so-everyone-will-have-the-same-pricing">Of course not. I understand that Resorts sets pricing so everyone will have the same pricing</option>&#13;
			<option label="I am already working with another agent" value="i-am-already-working-with-another-agent">I am already working with another agent</option>&#13;
			<option label="I plan to reach out to other agents" value="i-plan-to-reach-out-to-other-agents">I plan to reach out to other agents</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Where would you like to go?" name="checkbox-group-1767385127679">&#13;
			<option label="All Inclusive" value="all-inclusive">All Inclusive</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Hawaii" value="hawaii">Hawaii</option>&#13;
		</field>&#13;
		<field type="date" required="true" 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" required="true" 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" required="true" label="How many travelers?" name="text-1747062737563" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Names of adult travelers (18 and over)" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Names and ages of any children (under 18 at time of travel)- please provide ages for children at time of travel" name="text-1747062665183" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers (excluding flights)?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$2,000 to $5,000" value="2000-to-5000">$2,000 to $5,000</option>&#13;
			<option label="$5,000 to $7,000" value="5000-to-7000">$5,000 to $7,000</option>&#13;
			<option label="$7,000 to $10,000" value="7000-to-10000">$7,000 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="pageBreak" name="pageBreak-1768331636081" next="Next" previous="Previous"/>&#13;
		<field type="radio-group" required="true" label="What best describes your hotel preference?" name="hotel-preference">&#13;
			<option label="Value" value="Value">Value</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Deluxe" value="Deluxe">Deluxe</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have a resort preference or room type preference?&amp;nbsp;" description="Example: Suites- separate bedroom from living room  Pool or Resort View  Club Level" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" 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="I&#39;d love to connect with you on social media! If you have an Instagram account please share your handle below." name="text-1767382240391" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How did you hear about me? If a family member or friend referred you, I would love to thank them!" name="text-1767382330052" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
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