Share your information with Cassidy Wier

Cassidy Wier

Briar & Main Travel Boutique, LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#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="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="date" required="true" label="When would you like to depart?&amp;nbsp;" name="when-would-you-like-to-depart-" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?&amp;nbsp;" name="when-would-you-like-to-return-" className="form-control"/>&#13;
		<field type="radio-group" label="Are your dates flexible?&amp;nbsp;" name="are-your-dates-flexible-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is your departure city?&amp;nbsp;" name="what-is-your-departure-city-" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What type of trip are you planning?" name="what-best-describes-your-desired-accommodation-style-" other="true">&#13;
			<option label="Family Vacation" value="family-vacation">Family Vacation</option>&#13;
			<option label="Group Trip" value="group-trip">Group Trip</option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Solo Trip" value="solo-trip">Solo Trip</option>&#13;
			<option label="Destination Wedding" value="destination-wedding">Destination Wedding</option>&#13;
			<option label="Vow Renewal" value="vow-renewal">Vow Renewal</option>&#13;
			<option label="Romantic Getaway" value="romantic-getaway">Romantic Getaway</option>&#13;
			<option label="Family Reunion" value="family-reunion">Family Reunion</option>&#13;
			<option label="Corporate Incentive Trip" value="corporate-incentive-trip">Corporate Incentive Trip</option>&#13;
			<option label="Corporate Event" value="corporate-event">Corporate Event</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Destination" description="Select all that apply" name="destination" other="true">&#13;
			<option label="Walt Disney World" value="walt-disney-world">Walt Disney World</option>&#13;
			<option label="Universal Orlando" value="universal-orlando">Universal Orlando</option>&#13;
			<option label="Disneyland" value="disneyland">Disneyland</option>&#13;
			<option label="Adventures by Disney" value="adventures-by-disney">Adventures by Disney</option>&#13;
			<option label="Disney's Aulani" value="disneys-aulani">Disney's Aulani</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="River Cruise" value="river-cruise">River Cruise</option>&#13;
			<option label="Ocean Cruise" value="ocean-cruise">Ocean Cruise</option>&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="Asia" value="asia">Asia</option>&#13;
			<option label="Africa (Safari)" value="africa-safari">Africa (Safari)</option>&#13;
			<option label="South Pacific" value="south-pacific">South Pacific</option>&#13;
			<option label="Hawaii" value="hawaii">Hawaii</option>&#13;
			<option label="South America" value="south-america">South America</option>&#13;
			<option label="Central America" value="central-america">Central America</option>&#13;
			<option label="Egypt" value="egypt">Egypt</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Is this vacation to celebrate anything special?&amp;nbsp;" name="is-this-vacation-to-celebrate-anything-special-" className="form-control"/>&#13;
		<field type="textarea" required="true" label="How many adults and children (under 12) will be traveling?" description="Please include ages of children" name="who-will-be-traveling-please-list-all-full-names-including-middle-and-birthdays-" className="form-control"/>&#13;
		<field type="select" required="true" label="What is your total budget NOT including airfare?&amp;nbsp;" name="what-is-your-total-budget-not-including-airfare-" className="form-control">&#13;
			<option label="$3,500-7,500" value="35007500">$3,500-7,500</option>&#13;
			<option label="$7,500-10,000 " value="750010000-">$7,500-10,000 </option>&#13;
			<option label="$10,000-15,000  " value="1000015000-">$10,000-15,000  </option>&#13;
			<option label="$15,000-20,000" value="1500020000">$15,000-20,000</option>&#13;
			<option label="$20,000+" value="20000">$20,000+</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like us to know about your ideal vacation?&amp;nbsp;" name="what-else-would-you-like-me-to-know-about-your-ideal-vacation-" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="At what phase of planning are you in?&amp;nbsp;" name="at-what-phase-of-planning-are-you-in-">&#13;
			<option label="Just Researching" value="just-researching">Just Researching</option>&#13;
			<option label="Would like to book within the next 30 days" value="would-like-to-book-within-the-next-30-days">Would like to book within the next 30 days</option>&#13;
			<option label="Ready to Book" value="ready-to-book">Ready to Book</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="How did you find us?" name="how-did-you-find-us" className="form-control">&#13;
			<option label="Google" value="google">Google</option>&#13;
			<option label="Faceboook" value="faceboook">Faceboook</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Linkedin" value="linkedin">Linkedin</option>&#13;
			<option label="Tik Tok" value="tik-tok">Tik Tok</option>&#13;
			<option label="DWHSA" value="dwhsa">DWHSA</option>&#13;
			<option label="Arizona Bridal Magazine" value="arizona-bridal-magazine">Arizona Bridal Magazine</option>&#13;
			<option label="ASTA" value="asta">ASTA</option>&#13;
			<option label="Trade Show" value="trade-show">Trade Show</option>&#13;
			<option label="Agent Social Media" value="agent-social-media">Agent Social Media</option>&#13;
			<option label="Referral (let us know whom to thank!)" value="referral-let-us-know-whom-to-thank">Referral (let us know whom to thank!)</option>&#13;
		</field>&#13;
		<field type="text" label="If you were referred, please share who kindly referred you:" name="if-you-were-referred-please-share-who-kindly-referred-you" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="I understand that if traveling internationally, I must have a valid passport of at least 6 months after the date of return" name="i-understand-that-if-traveling-internationally-i-must-have-a-valid-passport-of-at-least-6-months-after-the-date-of-return">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="I am not traveling internationally" value="i-am-not-traveling-internationally">I am not traveling internationally</option>&#13;
		</field>&#13;
		<field type="select" label="Would you like to be subscribed to the Briar &amp;amp; Main® newsletter?&amp;nbsp;" name="would-you-like-to-be-subscribed-to-our-company-newsletter-" className="form-control">&#13;
			<option label="Yes- sign me up!" value="yes-sign-me-up">Yes- sign me up!</option>&#13;
			<option label="No, I get too many emails" value="no-i-get-too-many-emails">No, I get too many emails</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>