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Chemeeka Sparks

Chemeeka Sparks - Travelmation 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="Where would you like to travel?" 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="text" required="true" label="When would you like to go?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Text Field" name="text-1783533336664" value="When would you like to go?" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Text Area" name="textarea-1783533380242" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Do you have any accessibility needs that we need to accommodate?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Are there any allergies?" name="radio-group-1783510841706">&#13;
			<option label="" value=""/>&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="If yes, explain below:"/>&#13;
		<field type="textarea" label="Text Area" name="textarea-1783511313729" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Is there anything else that you would like me to know?"/>&#13;
		<field type="radio-group" label="Radio Group" name="radio-group-1783533422330">&#13;
			<option label="Option 1" value="option-1">Option 1</option>&#13;
			<option label="Option 2" value="option-2">Option 2</option>&#13;
			<option label="Option 3" value="option-3">Option 3</option>&#13;
		</field>&#13;
		<field type="textarea" label="Text Area" name="textarea-1783511904471" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Will you need flights?" name="radio-group-1783533407993">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" label="Select" name="select-1783533418992" className="form-control">&#13;
			<option label="Option 1" value="option-1" selected="selected">Option 1</option>&#13;
			<option label="Option 2" value="option-2">Option 2</option>&#13;
			<option label="Option 3" value="option-3">Option 3</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Radio Group" name="radio-group-1783533419983">&#13;
			<option label="Option 1" value="option-1">Option 1</option>&#13;
			<option label="Option 2" value="option-2">Option 2</option>&#13;
			<option label="Option 3" value="option-3">Option 3</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Contact Info"/>&#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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" 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" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is the best way to reach you?" name="radio-group-1783533716373">&#13;
			<option label="Phone call" value="phone-call">Phone call</option>&#13;
			<option label="Text message" value="text-message">Text message</option>&#13;
			<option label="Email " value="email-">Email </option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="How did you find me?" name="radio-group-1783533776626">&#13;
			<option label="TikTok" value="tiktok">TikTok</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Referral" value="referral">Referral</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>