Share your information with Amanda Larkin

Amanda Larkin

Travelmation - Amanda Larkin

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Vacation Questionnaire"/>&#13;
		<field type="header" subtype="h1" label="Contact Information"/>&#13;
		<field type="text" label="Prefix" 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" 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="checkbox-group" required="true" label="Preferred Method of Contact" inline="true" name="preferred-method-of-contact">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Any " value="any-">Any </option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Your Travel Plans"/>&#13;
		<field type="text" required="true" 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="text" label="What is your departure city/airport?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="When would you like to travel?" description="Please be specific. If you&#39;re not 100% sure  kindly include the month and year." name="when-would-you-like-to-travel" 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="radio-group" required="true" label="How soon are you looking to book?&amp;nbsp;" name="how-soon-are-you-looking-to-book-">&#13;
			<option label="Today" value="today">Today</option>&#13;
			<option label="Within next 7 - 10 days" value="within-next-7-10-days">Within next 7 - 10 days</option>&#13;
			<option label="In a few months" value="in-a-few-months">In a few months</option>&#13;
			<option label="Just considering options" value="just-considering-options">Just considering options</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many adults?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many kids?" name="text-1733270678596" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="How many rooms do you need?" name="how-many-rooms-do-you-need" other="true">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
		</field>&#13;
		<field type="textarea" label="First/Last Name as on Passport, Birthdate, Gender of entire party" name="firstlast-name-birthdate-gender" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What type of vacation are you planning?" name="which-of-the-following-will-you-need-for-your-vacation" other="true">&#13;
			<option label="Theme Park" value="theme-park">Theme Park</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="All Inclusive" value="all-inclusive">All Inclusive</option>&#13;
			<option label="International" value="international">International</option>&#13;
			<option label="Hotel &amp; Flight" value="hotel-flight">Hotel &amp; Flight</option>&#13;
			<option label="Hotel ONLY" value="hotel-only">Hotel ONLY</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Which of the following will you need in addition for your vacation?" name="checkbox-group-1733270502379" other="true">&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Ground Transportation/Shuttles" value="ground-transportationshuttles">Ground Transportation/Shuttles</option>&#13;
			<option label="Rental Car" value="rental-car">Rental Car</option>&#13;
			<option label="Excursions" value="excursions">Excursions</option>&#13;
			<option label="Equipment (Baby gear, ADA Gear)" value="equipment-baby-gear-ada-gear">Equipment (Baby gear, ADA Gear)</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Vacation Priorities" name="vacation-priorities">&#13;
			<option label="Adults-Only" value="adultsonly">Adults-Only</option>&#13;
			<option label="Family Friendly" value="family-friendly">Family Friendly</option>&#13;
			<option label="Lively Atmosphere" value="lively-atmosphere">Lively Atmosphere</option>&#13;
			<option label="Quiet Relaxation" value="quiet-relaxation">Quiet Relaxation</option>&#13;
			<option label="Adventurous Excursions" value="adventurous-excursions">Adventurous Excursions</option>&#13;
			<option label="Amazing Beach" value="amazing-beach">Amazing Beach</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Hotel Amenity Must-Haves" name="hotel-amenity-musthaves" other="true">&#13;
			<option label="All-Inclusive Resort" value="allinclusive-resort">All-Inclusive Resort</option>&#13;
			<option label="Excursions and Activities" value="excursions-and-activities">Excursions and Activities</option>&#13;
			<option label="Waterpark" value="waterpark">Waterpark</option>&#13;
			<option label="Full Kitchen" value="full-kitchen">Full Kitchen</option>&#13;
			<option label="Laundry" value="laundry">Laundry</option>&#13;
			<option label="Roll-In Shower" value="rollin-shower">Roll-In Shower</option>&#13;
			<option label="Other Accessible Features" value="other-accessible-features">Other Accessible Features</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Budget"/>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers, including flights?" description="This just gives me a general starting point and can always be changed later. I will do my best to search for the most value for your price point  but I ask your expectations to be realistic to match your budget." name="budget" other="true">&#13;
			<option label="$1,500 to $3,500" value="1500-to-3500">$1,500 to $3,500</option>&#13;
			<option label="$3,500 to $6,000" value="3500-to-6000">$3,500 to $6,000</option>&#13;
			<option label="$6,000 to $9,000" value="6000-to-9000">$6,000 to $9,000</option>&#13;
			<option label="$9,000 to $15,000" value="9000-to-15000">$9,000 to $15,000</option>&#13;
			<option label="$15,000 to $25,000" value="15000-to-25000">$15,000 to $25,000</option>&#13;
			<option label="$25,000+" value="25000">$25,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your price point?" name="what-best-describes-your-price-point">&#13;
			<option label="I am all about quality, price is not a concern" value="i-am-all-about-quality-price-is-not-a-concern">I am all about quality, price is not a concern</option>&#13;
			<option label="I am looking for the most economical deal" value="i-am-looking-for-the-most-economical-deal">I am looking for the most economical deal</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Other Information"/>&#13;
		<field type="radio-group" label="Are you interested in travel insurance?&amp;nbsp;" name="are-you-interested-in-travel-insurance-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Maybe" value="maybe">Maybe</option>&#13;
		</field>&#13;
		<field type="textarea" label="Who can I thank for referring you to me?" name="who-can-i-thank-for-referring-you-to-me" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Any Accessibility Concerns/Food Allergies/Medical Conditions/Extra Needs to be made aware of?&amp;nbsp;" description="(Diabetic   Autism Spectrum   Wheelchair   Gluten-free  Etc.)" name="any-food-allergiesmedical-conditions-to-be-made-aware-of-" 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;
	</fields>&#13;
</form-template>
  </body>
</html>