Share your information with Lauren Rotureau

Lauren Rotureau

Premier Resources Travel

<html>
  <body>
    <form-template>
	<fields>
		<field label="Questions for your trip" subtype="h2" type="header"/>
		<field description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." label="Where would you like to go?" name="destination" placeholder="ex: Tahiti" subtype="text" type="text" className="form-control"/>
		<field description="This just gives me a general idea of when you like to go; it can be changed later." label="When would you like to depart?" name="starting-at" type="date" className="form-control"/>
		<field description="This just gives me a general idea of when you like to return; it can be changed later." label="When would you like to return?" name="ending-at" type="date" className="form-control"/>
		<field label="Are your dates flexible?" name="dates-flexible" type="checkbox-group">
			<option label="Yes" value="yes">Yes</option>
		</field>
		<field description="Where will you be flying from?" label="What is your departure city?" name="departure-city" subtype="text" type="text" className="form-control"/>
		<field label="How many travelers?" name="number-of-travelers" type="text" className="form-control"/>
		<field description="This just gives me a general starting point and can always be changed later." label="What is your budget for all travelers?" name="budget" type="radio-group">
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>
			<option label="$10,000 to $15,000" value="10000-to-15000">$10,000 to $15,000</option>
			<option label="$15,000 to $20,000" value="15000-to-20000">$15,000 to $20,000</option>
			<option label="$20,000 +" value="20000-">$20,000 +</option>
		</field>
		<field label="What best describes your hotel preference?" name="hotel-preference" other="true" type="radio-group">
			<option label="Economy" value="value">Economy</option>
			<option label="Moderate" value="moderate">Moderate</option>
			<option label="Luxury" value="luxury">Luxury</option>
			<option label="Boutique" value="boutique">Boutique</option>
		</field>
		<field description="Check all that apply." label="What kind of vibe are you looking for?" name="vibe-preference" other="true" type="checkbox-group">
			<option label="Romantic" value="romantic">Romantic</option>
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>
			<option label="Party" value="party">Party</option>
			<option label="Local culture" value="local-culture">Local culture</option>
			<option label="Family friendly" value="family-friendly">Family friendly</option>
			<option label="Food and wine" value="food-wine">Food and wine</option>
		</field>
		<field description="Check all that apply" label="What activities are you interested in?" name="activity-preferences" other="true" type="checkbox-group">
			<option label="Beach and water" value="beach-water">Beach and water</option>
			<option label="Gambling" value="gambling">Gambling</option>
			<option label="Scuba" value="scuba">Scuba</option>
			<option label="Adventure activities" value="adventure">Adventure activities</option>
			<option label="Golf" value="golf">Golf</option>
			<option label="Nightlife" value="nightlife">Nightlife</option>
			<option label="Arts and theater" value="art-theater">Arts and theater</option>
		</field>
		<field label="Anything you absolutely must do or see?" name="must-dos" subtype="text" type="text" className="form-control"/>
		<field description="What else would you like me to know about your travelers  budget and/or travel preferences?" label="What else would you like me to know?" name="notes" type="textarea" className="form-control"/>
		<field required="true"  label="Email" name="email" subtype="text" type="text" className="form-control"/>
		<field label="Full name" subtype="h2" type="header"/>
		<field label="Prefix" name="prefix" subtype="text" type="text" className="form-control"/>
		<field label="First name" name="first-name" required="true" subtype="text" type="text" className="form-control"/>
		<field label="Middle name" name="middle-name" subtype="text" type="text" className="form-control"/>
		<field label="Last name" name="last-name" required="true" subtype="text" type="text" className="form-control"/>
		<field label="Suffix" name="suffix" subtype="text" type="text" className="form-control"/>
		<field label="Preferred name" name="preferred-name" subtype="text" type="text" className="form-control"/>
		<field label="Travel Preferences" subtype="h2" type="header"/>
		<field label="Seat preference" name="seat-preference" type="radio-group">
			<option label="Window" value="window">Window</option>
			<option label="Aisle" value="aisle">Aisle</option>
			<option label="Opposite aisle" value="opposite aisle">Opposite aisle</option>
		</field>
		<field label="Bed preference" name="bed-preference" type="radio-group">
			<option label="King" value="king">King</option>
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>
		</field>
		<field label="More Details&amp;nbsp;" subtype="h1" type="header"/>
		<field label="Phone number" name="phone-number" subtype="text" type="text" className="form-control"/>
		<field label="Do you prefer Adults/Couples Only?&amp;nbsp;&amp;nbsp;" name="do-you-prefer-adultscouples-only-" type="select" className="form-control">
			<option label="Yes" selected="selected" value="yes">Yes</option>
			<option label="No" value="no">No</option>
		</field>
		<field label="Is Nightlife/Entertainment Important?&amp;nbsp;" name="is-nightlifeentertainment-important-" type="select" className="form-control">
			<option label="Yes" selected="selected" value="yes">Yes</option>
			<option label="No" value="no">No</option>
		</field>
		<field label="Is a large, open beach important?&amp;nbsp;" name="is-a-large-open-beach-important-" type="radio-group">
			<option label="Yes" value="yes">Yes</option>
			<option label="No" value="no">No</option>
		</field>
		<field label="Is a Swim-up Bar important?&amp;nbsp;" name="is-a-swimup-bar-important" type="radio-group">
			<option label="Yes" value="yes">Yes</option>
			<option label="No" value="no">No</option>
		</field>
		<field label="Do you prefer an energetic environment or a more quieter/relaxing one?&amp;nbsp;" name="do-you-prefer-an-energetic-environment-or-a-more-quieterrelaxing-one-" type="radio-group">
			<option label="Lively/Energetic " value="livelyenergetic-">Lively/Energetic </option>
			<option label="Quieter/Relaxing " value="quieterrelaxing-">Quieter/Relaxing </option>
		</field>
		<field label="Are you looking for information now or ready to make a decision and book within the week?&amp;nbsp;" name="are-you-looking-for-information-now-or-ready-to-make-a-decision-and-book-within-the-week-" type="radio-group">
			<option label="Looking into options " value="looking-into-options-">Looking into options </option>
			<option label="Ready to book " value="ready-to-book-">Ready to book </option>
		</field>
		<field label="If this is an international trip - Do you have a valid passport?&amp;nbsp;" name="if-this-is-an-international-trip-do-you-have-a-valid-passport-" type="radio-group">
			<option label="Yes, I've had it for 6+ Months " value="yes-ive-had-it-for-6-months-">Yes, I've had it for 6+ Months </option>
			<option label="Yes, but it expires soon" value="yes-but-it-expires-soon">Yes, but it expires soon</option>
			<option label="No, but I'm going to apply for one " value="no-but-im-going-to-apply-for-one-">No, but I'm going to apply for one </option>
			<option label="N/A" value="na">N/A</option>
		</field>
		<field label="Hotel Amenities&amp;nbsp;" subtype="h1" type="header"/>
		<field label="Which view to do you prefer?&amp;nbsp;" name="which-view-to-do-you-prefer-" type="radio-group">
			<option label="Beach" value="beach">Beach</option>
			<option label="Tropical Garden " value="tropical-garden-">Tropical Garden </option>
		</field>
		<field label="Do you prefer a ground level room or balcony?&amp;nbsp;" name="do-you-prefer-a-ground-level-room-or-balcony-" type="radio-group">
			<option label="Ground Level" value="ground-level">Ground Level</option>
			<option label="Balcony " value="balcony-">Balcony </option>
		</field>
		<field label="Is Butler or Room Service a must?&amp;nbsp;" name="is-butler-or-room-service-a-must-" type="radio-group">
			<option label="Butler" value="butler">Butler</option>
			<option label="Room service " value="room-service-">Room service </option>
			<option label="N/A" value="na">N/A</option>
		</field>
		<field label="Is a stocked in-room minibar important?&amp;nbsp;" name="is-a-stocked-inroom-minibar-important-" type="radio-group">
			<option label="Yes" value="yes">Yes</option>
			<option label="No" value="no">No</option>
			<option label="N/A" value="na">N/A</option>
		</field>
	</fields>
</form-template>
  </body>
</html>