Share your information with Theresa Milks

Theresa Milks

Nova Travel Collective

<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="radio-group" label="Preferred method of communication" name="preferred-method-of-communication">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
		</field>&#13;
		<field type="text" label="How did you hear about us?" name="how-did-you-hear-about-us" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="What trip components would you like help with?" name="what-trip-components-would-you-like-help-with">&#13;
			<option label="Accomodations" value="accomodations">Accomodations</option>&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Tours &amp; Activities" value="tours-activities">Tours &amp; Activities</option>&#13;
			<option label="Transportation- transfers, car rental, trains, ferry, etc" value="transportation-transfers-car-rental-trains-ferry-etc">Transportation- transfers, car rental, trains, ferry, etc</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" label="Where would you like to go?" name="where-would-you-like-to-go" 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? If traveling with kids please list their ages." name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many total rooms?" name="how-many-total-rooms" 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="$4,000 to $6,000" value="4000-to-6000">$4,000 to $6,000</option>&#13;
			<option label="$6,000 to $8,000" value="6000-to-8000">$6,000 to $8,000</option>&#13;
			<option label="$8,500 to $10,000" value="8500-to-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
			<option label="Other" value="other">Other</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 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="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Please list all full names and birthdates for all travelers.&amp;nbsp;" name="please-list-all-full-names-and-birthdates-for-all-travelers-" className="form-control"/>&#13;
		<field type="text" label="Does everyone have a passport that is valid for at least six months after the travel return date?" name="does-everyone-have-a-passport-that-is-valid-for-at-least-six-months-after-the-travel-return-date" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Any pre-existing conditions, medical needs or food allergies we should be aware of?" name="any-preexisting-conditions-we-should-be-aware-of" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Some destinations have entry requirements that may be affected by prior legal history. Are you aware of any past legal issues that could impact your ability to enter another country?" name="checkbox-group-1775830830012">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="Any additional requests?" name="notes" className="form-control"/>&#13;
		<field type="checkbox-group" label="Would you like to be added to our email list?" name="would-you-like-to-be-added-to-our-email-list">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Acknowledgements&amp;nbsp;"/>&#13;
		<field type="checkbox-group" required="true" label="Please note that some of our proposals come from suppliers who provide bundled rates without breaking down individual components. This practice protects our valued partners who may have confidential, contracted rates from local vendors, and creates a seamless and holistic approach to your travel plans. Do you agree and understand that your proposal may come as one packaged rate and itemized pricing will not be available?&amp;nbsp;" name="checkbox-group-1775832328822">&#13;
			<option label="I understand and agree" value="i-understand-and-agree">I understand and agree</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="&amp;nbsp;I understand that I am responsible for confirming I meet all travel entry requirements, including any factors that may affect my admissibility to a destination." name="checkbox-group-1775830874207">&#13;
			<option label="I understand and agree" value="i-understand-and-agree">I understand and agree</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Terms &amp;amp; Conditions"/>&#13;
		<field type="paragraph" subtype="p" label="https://www.novatravelcollective.com/terms-privacy"/>&#13;
		<field type="checkbox-group" required="true" label="I have read and agree to the terms and conditions outlined by Nova Vacations (link above)." name="checkbox-group-1775833260397">&#13;
			<option label="yes" value="yes">yes</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>