Share your information with Vanesha Harrison

Vanesha Harrison

Harrison House Travel Agency LLC

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Your Name"/>&#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="header" subtype="h2" label="Group Info"/>&#13;
		<field type="text" required="true" label="Group Name" name="group-name" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Is there a confirmed group leader?" name="is-there-a-confirmed-group-leader">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Not yet" value="not-yet">Not yet</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Type of Group" name="type-of-group" other="true">&#13;
			<option label="Church" value="church">Church</option>&#13;
			<option label="Reunion" value="reunion">Reunion</option>&#13;
			<option label="Friends" value="friends">Friends</option>&#13;
			<option label="Wedding" value="wedding">Wedding</option>&#13;
			<option label="Family" value="family">Family</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Estimated travelers" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is the PER PERSON budget?" description="This just gives me a general starting point and can always be changed later." name="what-is-the-per-person-budget" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Preferred destination(s)" name="preferred-destinations" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What are your preferred departure airport(s), if needed?" name="text-1782417910151" 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="radio-group" required="true" label="Are these dates flexible?" name="radio-group-1782419418978">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Somewhat" value="somewhat">Somewhat</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="text" label="What kind of trip do you want this to be?" placeholder="Cruise? Resort? All-Inclusive? Etc... Let me know what you see for this group." name="what-kind-of-trip-do-you-want-this-to-be" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Bedding Preference" name="bedding-preference">&#13;
			<option label="King (1)" value="king-1">King (1)</option>&#13;
			<option label="Double/Queen  (2)" value="doublequeen-2">Double/Queen  (2)</option>&#13;
			<option label="Both" value="both">Both</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Budget Level" name="rooming-preference" other="true">&#13;
			<option label="Budget-friendly" value="budgetfriendly">Budget-friendly</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="radio-group" required="true" label="Travel Style" description="Check all that apply." name="travel-style" other="true">&#13;
			<option label="Religious" value="religious">Religious</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Multi-generational" value="multigenerational">Multi-generational</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Adults Only" value="adults-only">Adults Only</option>&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Food and wine" value="food-and-wine">Food and wine</option>&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Activities Your Group May Be Interested In" name="additional-activities" other="true">&#13;
			<option label="Beach and water" value="beach-and-water">Beach and water</option>&#13;
			<option label="Adventure activities" value="adventure-activities">Adventure activities</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Local food &amp; culture" value="local-food-culture">Local food &amp; culture</option>&#13;
		</field>&#13;
		<field type="textarea" label="Anything else you want me to know about the group?" name="what-are-some-musthaves" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>