Share your information with Brianna Yarbrough

Brianna Yarbrough

Pinks and Greens Travel Company

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="text" label="Where would you like to go?" 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="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="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="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</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;
		</field>&#13;
		<field type="text" required="true" label="Please include all traveler&#39;s names and ages below" description="( adult ages not required)" name="text-1768172998969" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What activities are you most interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Water park/Pool" value="water-parkpool">Water park/Pool</option>&#13;
			<option label="Thrill Rides / Coasters" value="thrill-rides-coasters">Thrill Rides / Coasters</option>&#13;
			<option label="Activities for Younger kids" value="activities-for-younger-kids">Activities for Younger kids</option>&#13;
			<option label="Princesses" value="princesses">Princesses</option>&#13;
			<option label="Super Nintendo World" value="super-nintendo-world">Super Nintendo World</option>&#13;
			<option label="Wizarding World - Harry Potter" value="wizarding-world-harry-potter">Wizarding World - Harry Potter</option>&#13;
			<option label="Princesses" value="princesses">Princesses</option>&#13;
			<option label="Jurassic Park - Dinosaurs " value="jurassic-park-dinosaurs-">Jurassic Park - Dinosaurs </option>&#13;
			<option label="How to train your Dragon -" value="how-to-train-your-dragon-">How to train your Dragon -</option>&#13;
			<option label="Lego land" value="lego-land">Lego land</option>&#13;
			<option label="Sea life/ sea world" value="sea-life-sea-world">Sea life/ sea world</option>&#13;
			<option label="Animals " value="animals-">Animals </option>&#13;
		</field>&#13;
		<field type="text" label="Are there any MUST do&#39;s while on your vacation?" description="( Specific rides  parks, or food that you want to try?)" name="text-1768172989292" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Are there any events you&#39;re most interested in?&amp;nbsp;" description="( Halloween Horror Nights  Mickey&#39;s Not So Scary, Mickey&#39;s Very Merry Christmas Party)" name="radio-group-1768172802375">&#13;
			<option label="Halloween Horror Nights" value="halloween-horror-nights">Halloween Horror Nights</option>&#13;
			<option label="Mickeys Not So Scary" value="mickeys-not-so-scary">Mickeys Not So Scary</option>&#13;
			<option label="Holidays At Universal" value="holidays-at-universal">Holidays At Universal</option>&#13;
			<option label="Mickey's Very Merry Christmas Part" value="mickeys-very-merry-christmas-part">Mickey's Very Merry Christmas Part</option>&#13;
			<option label="Jollywood Nights " value="jollywood-nights-">Jollywood Nights </option>&#13;
			<option label="Food and Wine ( Epcot)" value="food-and-wine-epcot">Food and Wine ( Epcot)</option>&#13;
			<option label="Mardi Gras at Universal" value="mardi-gras-at-universal">Mardi Gras at Universal</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>