Share your information with Bethany Herrera

Bethany Herrera

Travelmation LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="paragraph" subtype="p" label="Please complete the form below so that we can begin planning your dream vacation! Be sure to follow me on Social Media: *Facebook: https://www.facebook.com/bethanyherreratravel AND *Instagram: https://www.instagram.com/beyondwithchuckandbethany"/>&#13;
		<field type="header" subtype="h1" label="Personal Information"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Lead Guest 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="Lead Guest Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Suffix" name="suffix" 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="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" 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="header" subtype="h1" label="Travel Details"/>&#13;
		<field type="date" label="Departure Date" name="departure-date" className="form-control"/>&#13;
		<field type="date" label="Return Date" name="return-date" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Are your dates flexible?" name="are-your-dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Are you planning this trip as part of a group vacation?" name="checkbox-group-1752772721375">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Travelers"/>&#13;
		<field type="textarea" required="true" label="Will you be traveling with other adults? Please list their names below.&amp;nbsp;" placeholder="Please provide full names for all travelers. Example: Margaret Thorne" name="all-traveler-info" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Will you be traveling with children? Please list their names and birthdates below.&amp;nbsp;" placeholder="Example: Margie Thorne 1/2/2020" name="textarea-1751598837991" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Do any of the travelers require special needs or accessibility?" name="textarea-1752772646591" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Destinations and Interests"/>&#13;
		<field type="checkbox-group" required="true" label="Are you looking for beaches, pools, mountains, or something else?" name="checkbox-group-1752781629846" other="true">&#13;
			<option label="Beach" value="beach">Beach</option>&#13;
			<option label="Pool" value="pool">Pool</option>&#13;
			<option label="Mountains" value="mountains">Mountains</option>&#13;
		</field>&#13;
		<field type="textarea" label="What type of atmosphere/ambiance would best describe what you&#39;re looking for?" placeholder="Example: quiet  peaceful  relaxed  social, fun, upbeat, romantic, active, etc." name="textarea-1751599958406" className="form-control"/>&#13;
		<field type="textarea" label="Is there anything specific you would like to do or see while you are on your trip?" placeholder="Examples: spa  golf  shopping  site seeing, family activities, etc." name="textarea-1751599955929" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Do you have a preference for where you would like to go?" name="textarea-1752781880338" className="form-control"/>&#13;
		<field type="textarea" label="Anywhere you absolutely do NOT want to go?" name="textarea-1752781933791" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Any &quot;must haves&quot;?" name="do-you-have-a-specific-disney-resort-or-resorts-that-you-are-interested-in" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Any &quot;don&#39;t wants&quot;?" name="textarea-1752775650388" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Accommodations"/>&#13;
		<field type="checkbox-group" label="How important is the view from your room?" name="checkbox-group-1752785844523">&#13;
			<option label="Very Important" value="very-important">Very Important</option>&#13;
			<option label="Important" value="important">Important</option>&#13;
			<option label="Somewhat Important" value="somewhat-important">Somewhat Important</option>&#13;
			<option label="Not Important" value="not-important">Not Important</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="If the view is important, what type of view do you prefer?" placeholder="Examples: beach  pool  garden  mountain, etc." name="textarea-1752773921470" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Transportation"/>&#13;
		<field type="radio-group" required="true" label="Do you need airfare?" name="radio-group-1752776697760">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="If airfare is needed, which airport(s) are you willing to depart from?" name="textarea-1751601454681" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Budget"/>&#13;
		<field type="radio-group" required="true" label="What is your dream vacation budget?" name="preferred-budget">&#13;
			<option label="$1,500 to $2,500" value="1500-to-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 - $4,500" value="2500-4500">$2,500 - $4,500</option>&#13;
			<option label="$4,500 - $6,500" value="4500-6500">$4,500 - $6,500</option>&#13;
			<option label="$6,500-$8,500" value="65008500">$6,500-$8,500</option>&#13;
			<option label="$8,500-$10,000 " value="850010000-">$8,500-$10,000 </option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Additional Information"/>&#13;
		<field type="textarea" label="Are there any special occasions or celebrations during the trip?" name="textarea-1751682714842" className="form-control"/>&#13;
		<field type="textarea" label="Is there anything else I need to know about your vacation needs?" name="textarea-1751679012770" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>