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Vasti Hansley

A WanderLuxe Experience

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		<field type="header" subtype="h3" label="Package Type Selection"/>&#13;
		<field type="radio-group" required="true" label="I would like to sign up for this package option:&amp;nbsp;" name="i-would-like-to-sign-up-for-this-package-option-">&#13;
			<option label="$2282 pp, $384 deposit today  (flights, hotel, transportation)" value="2282-pp-384-deposit-today-flights-hotel-transportation">$2282 pp, $384 deposit today  (flights, hotel, transportation)</option>&#13;
			<option label="$1950 pp, $50 deposit today  (hotel and transportation, I will book my flight separately)" value="1950-pp-50-deposit-today-hotel-and-transportation-i-will-book-my-flight-separately">$1950 pp, $50 deposit today  (hotel and transportation, I will book my flight separately)</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Payment Plan Selection&amp;nbsp;"/>&#13;
		<field type="radio-group" required="true" label="I would like to do:&amp;nbsp;" name="i-would-like-to-do-">&#13;
			<option label="Plan 1: $363 due 1/30, 2/27, 3/27" value="plan-1-363-due-130-227-327">Plan 1: $363 due 1/30, 2/27, 3/27</option>&#13;
			<option label="Plan 2: $363 due 2/13, 3/13, 3/27" value="plan-2-363-due-213-313-327">Plan 2: $363 due 2/13, 3/13, 3/27</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="I would like to participate in the following excursions. Excursion pricing not included in package, will require payment by 4/20" name="i-would-like-to-participate-in-the-following-excursions-excursion-pricing-not-included-in-package-will-require-payment-by-420">&#13;
			<option label="Beachside Tacos &amp; Town Tour w/ Tequila tasting $78.40 pp" value="beachside-tacos-town-tour-w-tequila-tasting-7840-pp">Beachside Tacos &amp; Town Tour w/ Tequila tasting $78.40 pp</option>&#13;
			<option label="Chichen Itza, Cenote, &amp; Valladolid tour w/ lunch $52 pp" value="chichen-itza-cenote-valladolid-tour-w-lunch-52-pp">Chichen Itza, Cenote, &amp; Valladolid tour w/ lunch $52 pp</option>&#13;
			<option label="Adults only hip hop party boat $105 pp" value="adults-only-hip-hop-party-boat-105-pp">Adults only hip hop party boat $105 pp</option>&#13;
			<option label="Cancun street food tour $74 pp" value="cancun-street-food-tour-74-pp">Cancun street food tour $74 pp</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Traveler 1"/>&#13;
		<field type="text" required="true" label="Traveler 1 Last Name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Traveler 1 Last Name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Traveler 1 Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Traveler 1 Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City and State of Departure (current quote is flight from New Orleans, but quotes from another city can be provided at request)" name="city-and-state-of-departure-" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Traveler 2"/>&#13;
		<field type="text" required="true" label="Traveler 2 First Name&amp;nbsp;" name="traveler-2-first-name-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Traveler 2 Last Name&amp;nbsp;" name="traveler-2-last-name-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Traveler 2 Email" name="traveler-2-email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Traveler 2 Phone number" name="traveler-2-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City and State of Departure (current quote is flight from New Orleans, but quotes from another city can be provided at request)" name="text-1768155405836" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Travel Insurance Acknowledgement ($138 pp)" name="travel-insurance-acknowledgement-138-pp">&#13;
			<option label="I accept travel insurance and understand it must be paid by 2/6" value="i-accept-travel-insurance-and-understand-it-must-be-paid-by-26">I accept travel insurance and understand it must be paid by 2/6</option>&#13;
			<option label="I decline travel insurance at this time" value="i-decline-travel-insurance-at-this-time">I decline travel insurance at this time</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Terms &amp;amp; Acknowledgement: please check all boxes" inline="true" name="checkbox-group-1768154577724">&#13;
			<option label="I acknowledge pricing is subject to change until deposit is made" value="i-acknowledge-pricing-is-subject-to-change-until-deposit-is-made">I acknowledge pricing is subject to change until deposit is made</option>&#13;
			<option label="I acknowledge deposits are non-refundable unless stated otherwise" value="i-acknowledge-deposits-are-nonrefundable-unless-stated-otherwise">I acknowledge deposits are non-refundable unless stated otherwise</option>&#13;
			<option label="I have reviewed the trip details before submitting this form and I understand submission does not secure my spot until the deposit is received. " value="i-have-reviewed-the-trip-details-before-submitting-this-form-and-i-understand-submission-does-not-secure-my-spot-until-the-deposit-is-received-">I have reviewed the trip details before submitting this form and I understand submission does not secure my spot until the deposit is received. </option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
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