Jill Davies

Gilded Compass Tours/Striker Travel Group

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		<field type="header" subtype="h2" label="Please complete the required information so we can begin designing your Superbowl gameplan!"/>&#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" required="true" label="Email" name="email" 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="What is the name of your travel advisor?" description="Please tell us who refered you.  If you are a travel advisor  enter your name." name="what-is-the-name-of-your-travel-advisor" subtype="text" className="form-control"/>&#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="text" required="true" label="How many travelers total in your group?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Please list ALL travelers (include yourself) with ages.&amp;nbsp;" name="please-list-any-travelers-under-18-with-their-birthdates" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Which hotel is your preference?&amp;nbsp; St. Pierre requires a 4 nt stay Feb. 6-10 &amp;amp; Maison Dupwy requires a 3 nt stay Feb. 7-10." inline="true" name="pricepoint-per-person-not-including-airfare" other="true">&#13;
			<option label="St. Pierre Hotel- 4 nts" value="st-pierre-hotel-4-nts">St. Pierre Hotel- 4 nts</option>&#13;
			<option label="Maison Dupwy Hotel- 3 nts" value="maison-dupwy-hotel-3-nts">Maison Dupwy Hotel- 3 nts</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Acknowledgements (required)" name="acknowledgements-leave-blank-if-we-have-not-discussed">&#13;
			<option label="This is a nonrefundable room." value="this-is-a-nonrefundable-room">This is a nonrefundable room.</option>&#13;
			<option label="Bedding configuration can be requested but not guaranteed.  Assigned at checkin." value="bedding-configuration-can-be-requested-but-not-guaranteed-assigned-at-checkin">Bedding configuration can be requested but not guaranteed.  Assigned at checkin.</option>&#13;
			<option label="I will be offered travel insurance and understand my responsibility to purchase this within 2 weeks of my initial deposit. " value="i-will-be-offered-travel-insurance-and-understand-my-responsibility-to-purchase-this-within-2-weeks-of-my-initial-deposit-">I will be offered travel insurance and understand my responsibility to purchase this within 2 weeks of my initial deposit. </option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
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