<html> <body> <form-template> <fields> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Address"/> <field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="text" required="true" label="What destination(s) do you have in mind?" placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/> <field type="date" label="Preferred travel start date" name="preferred-travel-start-date" className="form-control"/> <field type="text" label="How many nights?&nbsp;" name="how-many-nights-" subtype="text" className="form-control"/> <field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" required="true" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="textarea" required="true" label="Please list the names and ages of all travelers" name="please-list-the-names-and-ages-of-all-travelers" className="form-control"/> <field type="checkbox-group" required="true" label="Which service are you interested in?" description="For a detailed description of these services please see our Services page." name="are-you-interested-in-doing-one-of-these-trips-below"> <option label="Hotel-Only" value="hotelonly">Hotel-Only</option> <option label="African Safari" value="african-safari">African Safari</option> <option label="Sun & Sand" value="sun-sand">Sun & Sand</option> <option label="Luxury Villa" value="luxury-villa">Luxury Villa</option> <option label="Ocean or River Cruise" value="ocean-or-river-cruise">Ocean or River Cruise</option> <option label="Honeymoon" value="honeymoon">Honeymoon</option> <option label="Custom Trip" value="custom-trip">Custom Trip</option> <option label="Book & Manage (you've picked out a tour and want us to book & manage it)" value="book-manage-youve-picked-out-a-tour-and-want-us-to-book-manage-it">Book & Manage (you've picked out a tour and want us to book & manage it)</option> <option label="Other" value="other">Other</option> </field> <field type="radio-group" required="true" label="What is your budget for all travelers not including airfare?" name="budget" other="true"> <option label="Hotel Only (Please list budget/night below)" value="hotel-only-please-list-budgetnight-below">Hotel Only (Please list budget/night below)</option> <option label="$10,000-$15,000" value="1000015000">$10,000-$15,000</option> <option label="$15,000-$25,000" value="1500025000">$15,000-$25,000</option> <option label="$25,000-$50,000" value="2500050000">$25,000-$50,000</option> <option label="$50,000+" value="50000">$50,000+</option> </field> <field type="text" label=""Hotel Only" budget per night" description="Only for "Hotel Only" bookings" name="hotel-only-budget-per-night" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="What best describes your hotel preference?&nbsp;" description="What style of hotel do you prefer?" name="hotel-preference" other="true"> <option label="Luxury: Four Seasons, Aman, Belmond, Dorchester, Rosewood, etc." value="luxury-four-seasons-aman-belmond-dorchester-rosewood-etc">Luxury: Four Seasons, Aman, Belmond, Dorchester, Rosewood, etc.</option> <option label="Boutique: Relais & Chateaux, Small Luxury Hotels, etc." value="boutique-relais-chateaux-small-luxury-hotels-etc">Boutique: Relais & Chateaux, Small Luxury Hotels, etc.</option> </field> <field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option> <option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option> <option label="Local culture" value="local-culture">Local culture</option> <option label="Family friendly" value="family-friendly">Family friendly</option> <option label="Food and wine" value="food-wine">Food and wine</option> <option label="Party" value="party">Party</option> </field> <field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true"> <option label="Beach and water" value="beach-and-water">Beach and water</option> <option label="Wine tasting" value="wine-tasting">Wine tasting</option> <option label="Adventure activities" value="adventure-activities">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theater" value="art-theater">Arts and theater</option> <option label="Sightseeing" value="sightseeing">Sightseeing</option> <option label="Wildlife" value="wildlife">Wildlife</option> </field> <field type="text" label="Are you celebrating a special occasion? If so, what are you celebrating?" name="are-you-celebrating-a-special-occasion-if-so-what-are-you-celebrating" subtype="text" className="form-control"/> <field type="radio-group" label="Would you like private touring?" name="would-you-like-private-touring" other="true"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="textarea" required="true" label="Please give us a brief description of your vision for the trip" name="please-give-us-a-brief-description-of-your-vision-for-the-trip" className="form-control"/> <field type="text" required="true" label="What is your favorite hotel in the world?" name="what-is-your-favorite-hotel-in-the-world" subtype="text" className="form-control"/> <field type="text" required="true" label="What destination have you traveled to that was your best vacation ever?" name="what-destination-have-you-traveled-to-that-was-your-best-vacation-ever" subtype="text" className="form-control"/> <field type="textarea" label="Anything else you would like us to know?&nbsp;Favorite travel memory? Travel pet-peeves? Allergies, dietary restrictions or other special needs?" name="notes" className="form-control"/> <field type="textarea" label="Who can we thank for referring you to us?" name="who-can-we-thank-for-referring-you-to-us" className="form-control"/> <field type="radio-group" required="true" label="By checking the box below, you are agreeing to Kristen Meckem Travel's Terms &amp; Conditions.&nbsp;" description="Please read below for Kristen Meckem Travel's Terms & Conditions." name="by-checking-the-box-below-you-are-agreeing-to-kristen-meckem-travels-terms-conditions-"> <option label="I agree" value="i-agree">I agree</option> <option label="I do not agree" value="i-do-not-agree">I do not agree</option> </field> <field type="radio-group" required="true" label="By checking the box below, you are agreeing to the Kristen Meckem Travel Privacy Policy." description="Please see below for Kristen Meckem Travel's Privacy Policy" name="by-checking-the-box-below-you-are-agreeing-to-the-kristen-meckem-travel-privacy-policy"> <option label="I agree" value="i-agree">I agree</option> <option label="I do not agree" value="i-do-not-agree">I do not agree</option> </field> <field type="radio-group" required="true" label="By checking the box below, you are agreeing that it is the responsibility of each traveler to complete country entry requirements, including but not limited to Visas, prescription medicines, vaccinations, and prevention medications." name="by-checking-the-box-below-you-are-agreeing-to-the-kristen-meckem-travel-covid19-waiver"> <option label="I agree" value="i-agree">I agree</option> <option label="I do not agree" value="i-do-not-agree">I do not agree</option> </field> <field type="radio-group" required="true" label="By checking the box below, you are agreeing that it is your responsibility to have current passports for all travelers (with an expiration date no less than 6 months after your return date of travel)." name="by-checking-the-box-below-you-are-agreeing-that-it-is-your-responsibility-to-have-current-passports-for-all-travelers-with-an-expiration-date-no-less-than-6-months-after-your-return-date-of-travel"> <option label="I agree" value="i-agree">I agree</option> <option label="I do not agree" value="i-do-not-agree">I do not agree</option> </field> </fields> </form-template> </body> </html>
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