Share your information with Christina Rockey

Christina Rockey

Vacation Architect LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#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="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="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#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="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Names and Ages at time of travel or Birthdates" description="This helps me get accurate pricing" name="names-and-ages-at-time-of-travel-or-birthdates" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your budget for all travelers?" description="Air  rental car  lodging" name="what-is-your-budget-for-all-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What best describes your travel 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 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;
			<option label="All-Inclusive" value="allinclusive">All-Inclusive</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
		</field>&#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;
		<field type="checkbox-group" required="true" label="Additional Accommodations Needed" description="For any member of the traveling party" name="additional-accommodations-needed" other="true">&#13;
			<option label="Specialty Meals (Vegan/Kosher/Other)" value="specialty-meals-vegankosherother">Specialty Meals (Vegan/Kosher/Other)</option>&#13;
			<option label="Food Allergies" value="food-allergies">Food Allergies</option>&#13;
			<option label="Wheelchair at Airport/Aircraft" value="wheelchair-at-airportaircraft">Wheelchair at Airport/Aircraft</option>&#13;
			<option label="Additional Leg Room" value="additional-leg-room">Additional Leg Room</option>&#13;
			<option label="Aircraft Seatbelt Extension/Additional Seat" value="aircraft-seatbelt-extensionadditional-seat">Aircraft Seatbelt Extension/Additional Seat</option>&#13;
			<option label="Car Seats" value="car-seats">Car Seats</option>&#13;
			<option label="Mobility Scooters" value="mobility-scooters">Mobility Scooters</option>&#13;
			<option label="None of the Above" value="none-of-the-above">None of the Above</option>&#13;
			<option label="Recovering" value="recovering">Recovering</option>&#13;
			<option label="Tobacco or Vape Used" value="tobacco-or-vape-used">Tobacco or Vape Used</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>