Share your information with Laci Jo Brimer

Laci Jo Brimer

Light My Path Travel

<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="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" 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" required="true" 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" required="true" 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="checkbox-group" required="true" label="What kind of trip are you wanting?" name="what-kind-of-trip-are-you-wanting" other="true">&#13;
			<option label="All Inclusive Resort" value="all-inclusive-resort">All Inclusive Resort</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Vacation Home" value="vacation-home">Vacation Home</option>&#13;
			<option label="Sporting Events" value="sporting-events">Sporting Events</option>&#13;
			<option label="Concerts/Shows" value="concertsshows">Concerts/Shows</option>&#13;
			<option label="Tours" value="tours">Tours</option>&#13;
			<option label="Weddings" value="weddings">Weddings</option>&#13;
			<option label="Car Rental" value="car-rental">Car Rental</option>&#13;
			<option label="Travel Insurance" value="travel-insurance">Travel Insurance</option>&#13;
			<option label="Transfers" value="transfers">Transfers</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many&amp;nbsp; adult travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many&amp;nbsp; children?&amp;nbsp;" description="Please list their ages at time of travel if possible." name="text-1740165356384" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Ages of children at the time of travel?&amp;nbsp;" description="Please list their ages at time of travel if possible." name="text-1741211464677" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many&amp;nbsp; rooms needed?" name="text-1740165448346" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many people staying in each room?" description="(i.e. 2 adults in room 1  2 adults/2 kids in room 2)" name="text-1740165540837" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your preferred accommodation type?" description="(i.e. standard room  ocean view  ocean front  balcony  suite, etc.)" name="text-1740165789406" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" 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" other="true">&#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="text" label="When are you looking to book this trip or make a deposit?" name="text-1744659921772" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" 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;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
			<option label="Snow Sports" value="snow-sports">Snow Sports</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Would you like travel protection?" name="would-you-like-travel-protection" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Have you ever worked with a travel agent?" name="text-1741211451023" 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" label="Anyone?" name="anyone">&#13;
			<option label="55+" value="55">55+</option>&#13;
			<option label="Law Enforcement" value="law-enforcement">Law Enforcement</option>&#13;
			<option label="Fire Department/EMT" value="fire-departmentemt">Fire Department/EMT</option>&#13;
			<option label="Military" value="military">Military</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Would you like to stay updated on travel deals and destinations by email?" name="would-you-like-to-stay-updated-on-travel-deals-and-destinations-by-email">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>