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Vanessa Dube

M Voyages et Aventures

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions pour votre voyage"/>&#13;
		<field type="header" subtype="h2" label="Nom et prénom"/>&#13;
		<field type="text" required="true" label="Prénom" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Deuxième prénom" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Nom de famille" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Adresse"/>&#13;
		<field type="text" label="Ligne 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Ligne 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Ville" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="État" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Pays" name="address-country" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="E-mail" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Numéro de téléphone" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Où aimerais-tu aller ?" 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="Quand souhaitez-vous partir ?" 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="Quand souhaitez-vous revenir ?" 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="Vos dates sont-elles flexibles ?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" label="Quelle est votre ville de départ ?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Combien de voyageurs ?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Quel est votre budget pour tous les voyageurs ?" 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="radio-group" label="Qu&#39;est-ce qui décrit le mieux votre préférence en matière d&#39;hôtel ?" 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="Quel genre d&#39;ambiance recherchez-vous ?" 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="Quelles activités vous intéressent ?" 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="Quelque chose que vous devez absolument faire ou voir ?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Que voudrais-tu que je sache d&#39;autre ?" 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>