Share your information with Sarah Chesnut

Sarah Chesnut

Story & Co.

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		<field type="header" subtype="h1" label="Travel Is The Healthiest Addiction"/>&#13;
		<field type="paragraph" subtype="p" label="sarah@travelstoryandco.com | 325.339.3608"/>&#13;
		<field type="paragraph" subtype="p" label="Welcome! I&#39;m so excited to plan your AMAZING vacation with you!"/>&#13;
		<field type="paragraph" subtype="p" label="To get started, I need a little information about you and your trip. Don&#39;t worry if you don&#39;t have all the details worked out yet - that&#39;s what I am here for! The below form is just to give me an idea of what you have in mind."/>&#13;
		<field type="paragraph" subtype="p" label="Rest assured, your privacy is VERY important to me! The information you provide below using our secure form will only be used for travel planning services with me, and will be shared with suppliers and vendors only as needed to plan and/or book your travel."/>&#13;
		<field type="paragraph" subtype="p" label="I will NEVER sell or give away your information."/>&#13;
		<field type="header" subtype="h2" label="Travel Information"/>&#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="Street Address" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Street Address 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 Code" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Country" placeholder="Please Select" name="address-country" className="form-control">&#13;
			<option label="Afghanistan" value="Afghanistan">Afghanistan</option>&#13;
			<option label="Albania" value="Albania">Albania</option>&#13;
			<option label="Algeria" value="Algeria">Algeria</option>&#13;
			<option label="American Samoa" value="American Samoa">American Samoa</option>&#13;
			<option label="Andorra" value="Andorra">Andorra</option>&#13;
			<option label="Angola" value="Angola">Angola</option>&#13;
			<option label="Anguilla" value="Anguilla">Anguilla</option>&#13;
			<option label="Antigua and Barbuda" value="Antigua and Barbuda">Antigua and Barbuda</option>&#13;
			<option label="Argentina" value="Argentina">Argentina</option>&#13;
			<option label="Armenia" value="Armenia">Armenia</option>&#13;
			<option label="Aruba" value="Aruba">Aruba</option>&#13;
			<option label="Australia" value="Australia">Australia</option>&#13;
			<option label="Austria" value="Austria">Austria</option>&#13;
			<option label="Azerbaijan" value="Azerbaijan">Azerbaijan</option>&#13;
			<option label="The Bahamas" value="The Bahamas">The Bahamas</option>&#13;
			<option label="Bahrain" value="Bahrain">Bahrain</option>&#13;
			<option label="Bangladesh" value="Bangladesh">Bangladesh</option>&#13;
			<option label="Barbados" value="Barbados">Barbados</option>&#13;
			<option label="Belarus" value="Belarus">Belarus</option>&#13;
			<option label="Belgium" value="Belgium">Belgium</option>&#13;
			<option label="Belize" value="Belize">Belize</option>&#13;
			<option label="Benin" value="Benin">Benin</option>&#13;
			<option label="Bermuda" value="Bermuda">Bermuda</option>&#13;
			<option label="Bhutan" value="Bhutan">Bhutan</option>&#13;
			<option label="Bolivia" value="Bolivia">Bolivia</option>&#13;
			<option label="Bosnia and Herzegovina" value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>&#13;
			<option label="Botswana" value="Botswana">Botswana</option>&#13;
			<option label="Brazil" value="Brazil">Brazil</option>&#13;
			<option label="Brunei" value="Brunei">Brunei</option>&#13;
			<option label="Bulgaria" value="Bulgaria">Bulgaria</option>&#13;
			<option label="Burkina Faso" value="Burkina Faso">Burkina Faso</option>&#13;
			<option label="Burundi" value="Burundi">Burundi</option>&#13;
			<option label="Cambodia" value="Cambodia">Cambodia</option>&#13;
			<option label="Cameroon" value="Cameroon">Cameroon</option>&#13;
			<option label="Canada" value="Canada">Canada</option>&#13;
			<option label="Cape Verde" value="Cape Verde">Cape Verde</option>&#13;
			<option label="Cayman Islands" value="Cayman Islands">Cayman Islands</option>&#13;
			<option label="Central African Republic" value="Central African Republic">Central African Republic</option>&#13;
			<option label="Chad" value="Chad">Chad</option>&#13;
			<option label="Chile" value="Chile">Chile</option>&#13;
			<option label="China" value="China">China</option>&#13;
			<option label="Christmas Island" value="Christmas Island">Christmas Island</option>&#13;
			<option label="Cocos (Keeling) Islands" value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>&#13;
			<option label="Colombia" value="Colombia">Colombia</option>&#13;
			<option label="Comoros" value="Comoros">Comoros</option>&#13;
			<option label="Congo" value="Congo">Congo</option>&#13;
			<option label="Cook Islands" value="Cook Islands">Cook Islands</option>&#13;
			<option label="Costa Rica" value="Costa Rica">Costa Rica</option>&#13;
			<option label="Cote d'Ivoire" value="Cote d'Ivoire">Cote d'Ivoire</option>&#13;
			<option label="Croatia" value="Croatia">Croatia</option>&#13;
			<option label="Cuba" value="Cuba">Cuba</option>&#13;
			<option label="Curaçao" value="Curaçao">Curaçao</option>&#13;
			<option label="Cyprus" value="Cyprus">Cyprus</option>&#13;
			<option label="Czech Republic" value="Czech Republic">Czech Republic</option>&#13;
			<option label="Democratic Republic of the Congo" value="Democratic Republic of the Congo">Democratic Republic of the Congo</option>&#13;
			<option label="Denmark" value="Denmark">Denmark</option>&#13;
			<option label="Djibouti" value="Djibouti">Djibouti</option>&#13;
			<option label="Dominica" value="Dominica">Dominica</option>&#13;
			<option label="Dominican Republic" value="Dominican Republic">Dominican Republic</option>&#13;
			<option label="Ecuador" value="Ecuador">Ecuador</option>&#13;
			<option label="Egypt" value="Egypt">Egypt</option>&#13;
			<option label="El Salvador" value="El Salvador">El Salvador</option>&#13;
			<option label="Equatorial Guinea" value="Equatorial Guinea">Equatorial Guinea</option>&#13;
			<option label="Eritrea" value="Eritrea">Eritrea</option>&#13;
			<option label="Estonia" value="Estonia">Estonia</option>&#13;
			<option label="Ethiopia" value="Ethiopia">Ethiopia</option>&#13;
			<option label="Falkland Islands" value="Falkland Islands">Falkland Islands</option>&#13;
			<option label="Faroe Islands" value="Faroe Islands">Faroe Islands</option>&#13;
			<option label="Fiji" value="Fiji">Fiji</option>&#13;
			<option label="Finland" value="Finland">Finland</option>&#13;
			<option label="France" value="France">France</option>&#13;
			<option label="French Polynesia" value="French Polynesia">French Polynesia</option>&#13;
			<option label="Gabon" value="Gabon">Gabon</option>&#13;
			<option label="The Gambia" value="The Gambia">The Gambia</option>&#13;
			<option label="Georgia" value="Georgia">Georgia</option>&#13;
			<option label="Germany" value="Germany">Germany</option>&#13;
			<option label="Ghana" value="Ghana">Ghana</option>&#13;
			<option label="Gibraltar" value="Gibraltar">Gibraltar</option>&#13;
			<option label="Greece" value="Greece">Greece</option>&#13;
			<option label="Greenland" value="Greenland">Greenland</option>&#13;
			<option label="Grenada" value="Grenada">Grenada</option>&#13;
			<option label="Guadeloupe" value="Guadeloupe">Guadeloupe</option>&#13;
			<option label="Guam" value="Guam">Guam</option>&#13;
			<option label="Guatemala" value="Guatemala">Guatemala</option>&#13;
			<option label="Guernsey" value="Guernsey">Guernsey</option>&#13;
			<option label="Guinea" value="Guinea">Guinea</option>&#13;
			<option label="Guinea-Bissau" value="Guinea-Bissau">Guinea-Bissau</option>&#13;
			<option label="Guyana" value="Guyana">Guyana</option>&#13;
			<option label="Haiti" value="Haiti">Haiti</option>&#13;
			<option label="Honduras" value="Honduras">Honduras</option>&#13;
			<option label="Hong Kong" value="Hong Kong">Hong Kong</option>&#13;
			<option label="Hungary" value="Hungary">Hungary</option>&#13;
			<option label="Iceland" value="Iceland">Iceland</option>&#13;
			<option label="India" value="India">India</option>&#13;
			<option label="Indonesia" value="Indonesia">Indonesia</option>&#13;
			<option label="Iran" value="Iran">Iran</option>&#13;
			<option label="Iraq" value="Iraq">Iraq</option>&#13;
			<option label="Ireland" value="Ireland">Ireland</option>&#13;
			<option label="Israel" value="Israel">Israel</option>&#13;
			<option label="Italy" value="Italy">Italy</option>&#13;
			<option label="Jamaica" value="Jamaica">Jamaica</option>&#13;
			<option label="Japan" value="Japan">Japan</option>&#13;
			<option label="Jersey" value="Jersey">Jersey</option>&#13;
			<option label="Jordan" value="Jordan">Jordan</option>&#13;
			<option label="Kazakhstan" value="Kazakhstan">Kazakhstan</option>&#13;
			<option label="Kenya" value="Kenya">Kenya</option>&#13;
			<option label="Kiribati" value="Kiribati">Kiribati</option>&#13;
			<option label="North Korea" value="North Korea">North Korea</option>&#13;
			<option label="South Korea" value="South Korea">South Korea</option>&#13;
			<option label="Kosovo" value="Kosovo">Kosovo</option>&#13;
			<option label="Kuwait" value="Kuwait">Kuwait</option>&#13;
			<option label="Kyrgyzstan" value="Kyrgyzstan">Kyrgyzstan</option>&#13;
			<option label="Laos" value="Laos">Laos</option>&#13;
			<option label="Latvia" value="Latvia">Latvia</option>&#13;
			<option label="Lebanon" value="Lebanon">Lebanon</option>&#13;
			<option label="Lesotho" value="Lesotho">Lesotho</option>&#13;
			<option label="Liberia" value="Liberia">Liberia</option>&#13;
			<option label="Libya" value="Libya">Libya</option>&#13;
			<option label="Liechtenstein" value="Liechtenstein">Liechtenstein</option>&#13;
			<option label="Lithuania" value="Lithuania">Lithuania</option>&#13;
			<option label="Luxembourg" value="Luxembourg">Luxembourg</option>&#13;
			<option label="Macau" value="Macau">Macau</option>&#13;
			<option label="Macedonia" value="Macedonia">Macedonia</option>&#13;
			<option label="Madagascar" value="Madagascar">Madagascar</option>&#13;
			<option label="Malawi" value="Malawi">Malawi</option>&#13;
			<option label="Malaysia" value="Malaysia">Malaysia</option>&#13;
			<option label="Maldives" value="Maldives">Maldives</option>&#13;
			<option label="Mali" value="Mali">Mali</option>&#13;
			<option label="Malta" value="Malta">Malta</option>&#13;
			<option label="Marshall Islands" value="Marshall Islands">Marshall Islands</option>&#13;
			<option label="Martinique" value="Martinique">Martinique</option>&#13;
			<option label="Mauritania" value="Mauritania">Mauritania</option>&#13;
			<option label="Mauritius" value="Mauritius">Mauritius</option>&#13;
			<option label="Mayotte" value="Mayotte">Mayotte</option>&#13;
			<option label="Mexico" value="Mexico">Mexico</option>&#13;
			<option label="Micronesia" value="Micronesia">Micronesia</option>&#13;
			<option label="Moldova" value="Moldova">Moldova</option>&#13;
			<option label="Monaco" value="Monaco">Monaco</option>&#13;
			<option label="Mongolia" value="Mongolia">Mongolia</option>&#13;
			<option label="Montenegro" value="Montenegro">Montenegro</option>&#13;
			<option label="Montserrat" value="Montserrat">Montserrat</option>&#13;
			<option label="Morocco" value="Morocco">Morocco</option>&#13;
			<option label="Mozambique" value="Mozambique">Mozambique</option>&#13;
			<option label="Myanmar" value="Myanmar">Myanmar</option>&#13;
			<option label="Nagorno-Karabakh" value="Nagorno-Karabakh">Nagorno-Karabakh</option>&#13;
			<option label="Namibia" value="Namibia">Namibia</option>&#13;
			<option label="Nauru" value="Nauru">Nauru</option>&#13;
			<option label="Nepal" value="Nepal">Nepal</option>&#13;
			<option label="Netherlands" value="Netherlands">Netherlands</option>&#13;
			<option label="Netherlands Antilles" value="Netherlands Antilles">Netherlands Antilles</option>&#13;
			<option label="New Caledonia" value="New Caledonia">New Caledonia</option>&#13;
			<option label="New Zealand" value="New Zealand">New Zealand</option>&#13;
			<option label="Nicaragua" value="Nicaragua">Nicaragua</option>&#13;
			<option label="Niger" value="Niger">Niger</option>&#13;
			<option label="Nigeria" value="Nigeria">Nigeria</option>&#13;
			<option label="Niue" value="Niue">Niue</option>&#13;
			<option label="Norfolk Island" value="Norfolk Island">Norfolk Island</option>&#13;
			<option label="Turkish Republic of Northern Cyprus" value="Turkish Republic of Northern Cyprus">Turkish Republic of Northern Cyprus</option>&#13;
			<option label="Northern Mariana" value="Northern Mariana">Northern Mariana</option>&#13;
			<option label="Norway" value="Norway">Norway</option>&#13;
			<option label="Oman" value="Oman">Oman</option>&#13;
			<option label="Pakistan" value="Pakistan">Pakistan</option>&#13;
			<option label="Palau" value="Palau">Palau</option>&#13;
			<option label="Palestine" value="Palestine">Palestine</option>&#13;
			<option label="Panama" value="Panama">Panama</option>&#13;
			<option label="Papua New Guinea" value="Papua New Guinea">Papua New Guinea</option>&#13;
			<option label="Paraguay" value="Paraguay">Paraguay</option>&#13;
			<option label="Peru" value="Peru">Peru</option>&#13;
			<option label="Philippines" value="Philippines">Philippines</option>&#13;
			<option label="Pitcairn Islands" value="Pitcairn Islands">Pitcairn Islands</option>&#13;
			<option label="Poland" value="Poland">Poland</option>&#13;
			<option label="Portugal" value="Portugal">Portugal</option>&#13;
			<option label="Puerto Rico" value="Puerto Rico">Puerto Rico</option>&#13;
			<option label="Qatar" value="Qatar">Qatar</option>&#13;
			<option label="Republic of the Congo" value="Republic of the Congo">Republic of the Congo</option>&#13;
			<option label="Romania" value="Romania">Romania</option>&#13;
			<option label="Russia" value="Russia">Russia</option>&#13;
			<option label="Rwanda" value="Rwanda">Rwanda</option>&#13;
			<option label="Saint Barthelemy" value="Saint Barthelemy">Saint Barthelemy</option>&#13;
			<option label="Saint Helena" value="Saint Helena">Saint Helena</option>&#13;
			<option label="Saint Kitts and Nevis" value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>&#13;
			<option label="Saint Lucia" value="Saint Lucia">Saint Lucia</option>&#13;
			<option label="Saint Martin" value="Saint Martin">Saint Martin</option>&#13;
			<option label="Saint Pierre and Miquelon" value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>&#13;
			<option label="Saint Vincent and the Grenadines" value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>&#13;
			<option label="Samoa" value="Samoa">Samoa</option>&#13;
			<option label="San Marino" value="San Marino">San Marino</option>&#13;
			<option label="Sao Tome and Principe" value="Sao Tome and Principe">Sao Tome and Principe</option>&#13;
			<option label="Saudi Arabia" value="Saudi Arabia">Saudi Arabia</option>&#13;
			<option label="Senegal" value="Senegal">Senegal</option>&#13;
			<option label="Serbia" value="Serbia">Serbia</option>&#13;
			<option label="Seychelles" value="Seychelles">Seychelles</option>&#13;
			<option label="Sierra Leone" value="Sierra Leone">Sierra Leone</option>&#13;
			<option label="Singapore" value="Singapore">Singapore</option>&#13;
			<option label="Slovakia" value="Slovakia">Slovakia</option>&#13;
			<option label="Slovenia" value="Slovenia">Slovenia</option>&#13;
			<option label="Solomon Islands" value="Solomon Islands">Solomon Islands</option>&#13;
			<option label="Somalia" value="Somalia">Somalia</option>&#13;
			<option label="Somaliland" value="Somaliland">Somaliland</option>&#13;
			<option label="South Africa" value="South Africa">South Africa</option>&#13;
			<option label="South Ossetia" value="South Ossetia">South Ossetia</option>&#13;
			<option label="South Sudan" value="South Sudan">South Sudan</option>&#13;
			<option label="Spain" value="Spain">Spain</option>&#13;
			<option label="Sri Lanka" value="Sri Lanka">Sri Lanka</option>&#13;
			<option label="Sudan" value="Sudan">Sudan</option>&#13;
			<option label="Suriname" value="Suriname">Suriname</option>&#13;
			<option label="Svalbard" value="Svalbard">Svalbard</option>&#13;
			<option label="eSwatini" value="eSwatini">eSwatini</option>&#13;
			<option label="Sweden" value="Sweden">Sweden</option>&#13;
			<option label="Switzerland" value="Switzerland">Switzerland</option>&#13;
			<option label="Syria" value="Syria">Syria</option>&#13;
			<option label="Taiwan" value="Taiwan">Taiwan</option>&#13;
			<option label="Tajikistan" value="Tajikistan">Tajikistan</option>&#13;
			<option label="Tanzania" value="Tanzania">Tanzania</option>&#13;
			<option label="Thailand" value="Thailand">Thailand</option>&#13;
			<option label="Timor-Leste" value="Timor-Leste">Timor-Leste</option>&#13;
			<option label="Togo" value="Togo">Togo</option>&#13;
			<option label="Tokelau" value="Tokelau">Tokelau</option>&#13;
			<option label="Tonga" value="Tonga">Tonga</option>&#13;
			<option label="Transnistria Pridnestrovie" value="Transnistria Pridnestrovie">Transnistria Pridnestrovie</option>&#13;
			<option label="Trinidad and Tobago" value="Trinidad and Tobago">Trinidad and Tobago</option>&#13;
			<option label="Tristan da Cunha" value="Tristan da Cunha">Tristan da Cunha</option>&#13;
			<option label="Tunisia" value="Tunisia">Tunisia</option>&#13;
			<option label="Turkey" value="Turkey">Turkey</option>&#13;
			<option label="Turkmenistan" value="Turkmenistan">Turkmenistan</option>&#13;
			<option label="Turks and Caicos Islands" value="Turks and Caicos Islands">Turks and Caicos Islands</option>&#13;
			<option label="Tuvalu" value="Tuvalu">Tuvalu</option>&#13;
			<option label="Uganda" value="Uganda">Uganda</option>&#13;
			<option label="Ukraine" value="Ukraine">Ukraine</option>&#13;
			<option label="United Arab Emirates" value="United Arab Emirates">United Arab Emirates</option>&#13;
			<option label="United Kingdom" value="United Kingdom">United Kingdom</option>&#13;
			<option label="United States" value="United States">United States</option>&#13;
			<option label="Uruguay" value="Uruguay">Uruguay</option>&#13;
			<option label="Uzbekistan" value="Uzbekistan">Uzbekistan</option>&#13;
			<option label="Vanuatu" value="Vanuatu">Vanuatu</option>&#13;
			<option label="Vatican City" value="Vatican City">Vatican City</option>&#13;
			<option label="Venezuela" value="Venezuela">Venezuela</option>&#13;
			<option label="Vietnam" value="Vietnam">Vietnam</option>&#13;
			<option label="British Virgin Islands" value="British Virgin Islands">British Virgin Islands</option>&#13;
			<option label="Isle of Man" value="Isle of Man">Isle of Man</option>&#13;
			<option label="US Virgin Islands" value="US Virgin Islands">US Virgin Islands</option>&#13;
			<option label="Wallis and Futuna" value="Wallis and Futuna">Wallis and Futuna</option>&#13;
			<option label="Western Sahara" value="Western Sahara">Western Sahara</option>&#13;
			<option label="Yemen" value="Yemen">Yemen</option>&#13;
			<option label="Zambia" value="Zambia">Zambia</option>&#13;
			<option label="Zimbabwe" value="Zimbabwe">Zimbabwe</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" subtype="email" required="true" label="E-mail" placeholder="ex: myname@example.com" name="email" className="form-control"/>&#13;
		<field type="text" subtype="tel" required="true" label="Phone Number" description="Format: (000) 000-0000." placeholder="(000) 000-0000" name="phone-number" className="form-control"/>&#13;
		<field type="text" required="true" label="Preferred Method of Communication" name="preferred-method-of-communication" subtype="text" className="form-control"/>&#13;
		<field type="text" 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="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="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" 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="checkbox-group" label="Trip Duration:" name="trip-duration" className="checkbox-group">&#13;
			<option label="3-4 Days" value="3-4 Days">3-4 Days</option>&#13;
			<option label="5-7 Days" value="5-7 Days">5-7 Days</option>&#13;
			<option label="8-14 Days" value="8-14 Days">8-14 Days</option>&#13;
			<option label="Over 14 Days" value="Over 14 Days">Over 14 Days</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="What&#39;s Your Travel Style?"/>&#13;
		<field type="checkbox-group" required="true" label="We want to learn more about your travels to better assist you with planning :) Check ALL that apply." name="travel-style" className="checkbox-group">&#13;
			<option label="All Inclusive (Adult Only)" value="All Inclusive (Adult Only)">All Inclusive (Adult Only)</option>&#13;
			<option label="All Inclusive (Family Friendly)" value="All Inclusive (Family Friendly)">All Inclusive (Family Friendly)</option>&#13;
			<option label="Ocean Cruise" value="Ocean Cruise">Ocean Cruise</option>&#13;
			<option label="Solo Vacation" value="Solo Vacation">Solo Vacation</option>&#13;
			<option label="Mancation (Only for Men)" value="Mancation (Only for Men)">Mancation (Only for Men)</option>&#13;
			<option label="Group Vacation (8 or more)" value="Group Vacation (8 or more)">Group Vacation (8 or more)</option>&#13;
			<option label="Girlfriends Getaway" value="Girlfriends Getaway">Girlfriends Getaway</option>&#13;
			<option label="Adventures by Disney" value="Adventures by Disney">Adventures by Disney</option>&#13;
			<option label="Outdoor Adventure" value="Outdoor Adventure">Outdoor Adventure</option>&#13;
			<option label="Tickets and Events" value="Tickets and Events">Tickets and Events</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#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="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</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="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Payment Preference" name="checkbox-group-1778111079862">&#13;
			<option label="I plan to pay the full balance at the time of booking." value="i-plan-to-pay-the-full-balance-at-the-time-of-booking">I plan to pay the full balance at the time of booking.</option>&#13;
			<option label="I am interested in a flexible payment plan (Deposit now, balance paid over time.)" value="i-am-interested-in-a-flexible-payment-plan-deposit-now-balance-paid-over-time">I am interested in a flexible payment plan (Deposit now, balance paid over time.)</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="Dream Big!!! This is your bucket list."/>&#13;
		<field type="header" subtype="h2" label="How did you hear about us?"/>&#13;
		<field type="checkbox-group" required="true" label="Check as many as apply" name="know-about-us" other="true" className="checkbox-group">&#13;
			<option label="Google Search" value="Google Search">Google Search</option>&#13;
			<option label="Facebook" value="Facebook">Facebook</option>&#13;
			<option label="Instagram" value="Instagram">Instagram</option>&#13;
			<option label="Word of mouth" value="Word of mouth">Word of mouth</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Congratulations !"/>&#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>