Share your information with Glynis Freeman

Glynis Freeman

Atlanta Travel Associates

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Client Inquiry &amp;amp; Trip Detail Form"/>&#13;
		<field type="text" required="true" label="Prefix" placeholder="Mr.  or Mrs. | Ms. | Miss  etc." 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" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" 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="h2" label="Tell us more about your vacation"/>&#13;
		<field type="select" label="Is this reservation for an INDIVIDUAL or GROUP reservation" description="If reservation less than 10 rooms select Individual. More than 10 select Group" name="is-this-reservation-for-an-individual-or-group-reservation" className="form-control">&#13;
			<option label="Individual" value="individual" selected="selected">Individual</option>&#13;
			<option label="Group" value="group">Group</option>&#13;
		</field>&#13;
		<field type="radio-group" label="How many guests rooms do your require?&amp;nbsp;" inline="true" name="how-many-guests-rooms-do-your-require-" 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;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
		</field>&#13;
		<field type="radio-group" label="How many guests will there be in each room?" inline="true" name="how-many-guests-will-there-be-in-each-room" 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="select" label="What type of vacation are you interested in taking?&amp;nbsp;" description="To make multiple selections  please hold the &quot;Ctrl&quot; key  and  click on selections" placeholder="Select one or more below" name="what-type-of-vacation-are-you-interested-in-taking-cruise-or-allinclusive-or-other" multiple="multiple" className="form-control">&#13;
			<option label="All-Inclusive Vacation" value="allinclusive-vacation">All-Inclusive Vacation</option>&#13;
			<option label="Cruise Vacation" value="cruise-vacation">Cruise Vacation</option>&#13;
			<option label="River Cruise" value="river-cruise">River Cruise</option>&#13;
			<option label="Escorted Tour Package" value="escorted-tour-package">Escorted Tour Package</option>&#13;
			<option label="Hotel Only" value="hotel-only">Hotel Only</option>&#13;
			<option label="Car Rental" value="car-rental">Car Rental</option>&#13;
			<option label="Air Only" value="air-only">Air Only</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" label="Which destination(s) would you like to visit during this trip?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: South Africa  or Jamaica   or Europe, Walt Disney" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many days would you like to travel?" placeholder="3, 4, 5 or more days" name="how-many-days-would-you-like-to-travel" 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="checkbox-group" label="Are your dates flexible?" inline="true" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="What is the closest airport located near you?" description="Where will you be flying from?" placeholder="Enter &quot;Airport Code&quot; or City" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Do you have a budget in mind for how much you would like to spend for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget" other="true">&#13;
			<option label="$500.00 to $1,499" value="50000-to-1499">$500.00 to $1,499</option>&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,600 to $4,500" value="2600-to-4500">$2,600 to $4,500</option>&#13;
			<option label="$4,600 to $6,500" value="4600-to-6500">$4,600 to $6,500</option>&#13;
			<option label="$6,600 to $8,500" value="6600-to-8500">$6,600 to $8,500</option>&#13;
			<option label="$8,600 to $10,000" value="8600-to-10000">$8,600 to $10,000</option>&#13;
			<option label="$10,100+" value="10100">$10,100+</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 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="checkbox-group" label="What type of 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="text" label="Is there anything you absolutely must do or see while on vacation?" placeholder="Example:  My dream is to visit the Effiel Tower while on vacation" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Are there any additional details you would like to share regarding your&amp;nbsp; vacation?" description="Are you celebrating a special birthday? Anniversary? Reunion?" placeholder="Example: I am celebrating my 30 birthday.  This is our 25th Anniversary." name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>