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Justina Brklycica
Distinct Travel LLC
<html> <body> <form-template> <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="header" subtype="h2" label="Let's Plan the Perfect River Cruise for You!"/> <field type="header" subtype="h1" label="Preliminary Planning Form"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Is the number you provided a cell phone?" inline="true" name="is-the-number-you-provided-a-cell-phone"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Dates you would like to travel" name="dates-you-would-like-to-travel" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="How many staterooms do you need?" inline="true" name="how-many-staterooms-do-you-need" other="true"> <option label="1" value="1">1</option> <option label="2" value="2">2</option> <option label="3" value="3">3</option> </field> <field type="text" label="If any of the travelers have any special stateroom needs or requirements, please list them here" name="if-any-of-the-travelers-have-any-special-stateroom-needs-or-requirements-please-list-them-here" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Previous River Cruises"/> <field type="radio-group" required="true" label="Have you ever been on a river cruise before?" inline="true" name="have-you-ever-been-on-a-river-cruise-before"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="textarea" label="If yes, please list the RIVER BOAT CRUISE LINE, the RIVERS(s) you sailed and the MONTH/YEAR of your cruises" name="if-yes-please-list-the-river-boat-cruise-line-the-riverss-you-sailed-and-the-monthyear-of-your-cruises" className="form-control"/> <field type="radio-group" label="Would you sail these brand(s) again?" inline="true" name="would-you-sail-these-brands-again"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="What did you love about your river cruise(s)?" name="what-did-you-love-about-your-river-cruises" subtype="text" className="form-control"/> <field type="text" label="What did you dislike about your river cruise(s)?" name="what-did-you-dislike-about-your-river-cruises" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="This Trip:&nbsp; Preferences"/> <field type="radio-group" required="true" label="How long do you want to cruise?" name="how-long-do-you-want-to-cruise" other="true"> <option label="7 nights" value="7-nights">7 nights</option> <option label="8 to 10 nights" value="8-to-10-nights">8 to 10 nights</option> <option label="11 to 15 nights" value="11-to-15-nights">11 to 15 nights</option> <option label="I'm interested in back-to-back cruises" value="im-interested-in-backtoback-cruises">I'm interested in back-to-back cruises</option> </field> <field type="radio-group" required="true" label="Are you interested in a PRE-cruise stay?" inline="true" name="are-you-interested-in-a-precruise-stay"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="Not sure" value="not-sure">Not sure</option> </field> <field type="radio-group" required="true" label="Are you interested in a POST-cruise stay?" inline="true" name="are-you-interested-in-a-postcruise-stay"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="Not sure" value="not-sure">Not sure</option> </field> <field type="checkbox-group" required="true" label="What class of river cruise experience are you interested in?" inline="true" name="what-level-of-service-are-you-interested-in"> <option label="3 star" value="3-star">3 star</option> <option label="4 star" value="4-star">4 star</option> <option label="5 star" value="5-star">5 star</option> </field> <field type="text" required="true" label="Any amenities that you must have on your ship (gym, spa, etc.)?" name="any-amenities-that-you-must-have-on-your-ship-gym-spa-etc" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Some bathrooms -- specifically showers -- can be quite small on some river cruise ships. Will this be an issue for anyone in your group?" inline="true" name="some-bathrooms-specifically-showers-can-be-quite-small-on-some-river-cruise-ships-will-this-be-an-issue-for-anyone-in-your-group"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="Possibly" value="possibly">Possibly</option> </field> <field type="checkbox-group" required="true" label="In terms of style and decor, which appeals most? (check all that apply)" name="in-terms-of-style-and-decor-which-appeals-most-check-all-that-apply"> <option label="Modern and sleek" value="modern-and-sleek">Modern and sleek</option> <option label="Neutrals and cozy" value="neutrals-and-cozy">Neutrals and cozy</option> <option label="Colorful patterns and textures" value="colorful-patterns-and-textures">Colorful patterns and textures</option> <option label="Lush and sophisticated" value="lush-and-sophisticated">Lush and sophisticated</option> <option label="Minimalist and simple" value="minimalist-and-simple">Minimalist and simple</option> </field> <field type="text" required="true" label="Is there a particular river you want to sail or country(ies) you would like to visit?" name="is-there-a-particular-river-you-want-to-sail-or-countryies-you-would-like-to-visit" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="How important is good weather?" name="how-important-is-good-weather"> <option label="I want the best possible weather despite the higher cruise rates." value="i-want-the-best-possible-weather-despite-the-higher-cruise-rates">I want the best possible weather despite the higher cruise rates.</option> <option label="I want decent weather, but for a better cruise rate, cooler days with potential rain is OK." value="i-want-decent-weather-but-for-a-better-cruise-rate-cooler-days-with-potential-rain-is-ok">I want decent weather, but for a better cruise rate, cooler days with potential rain is OK.</option> <option label="There is no bad weather. Just bad clothes. I'm most interested in a lower cruise rate." value="there-is-no-bad-weather-just-bad-clothes-im-most-interested-in-a-lower-cruise-rate">There is no bad weather. Just bad clothes. I'm most interested in a lower cruise rate.</option> </field> <field type="radio-group" required="true" label="Check the box that most applies" name="check-the-box-that-most-applies"> <option label="We will want to enjoy cocktails, wine, etc. on the ship" value="we-will-want-to-enjoy-cocktails-wine-etc-on-the-ship">We will want to enjoy cocktails, wine, etc. on the ship</option> <option label="We may have a couple cocktails, but it's not an important element of our trip" value="we-may-have-a-couple-cocktails-but-its-not-an-important-element-of-our-trip">We may have a couple cocktails, but it's not an important element of our trip</option> <option label="We do not drink" value="we-do-not-drink">We do not drink</option> </field> <field type="radio-group" required="true" label="Select the option that best describes your preferred activity level" name="select-the-option-that-best-describes-your-preferred-activity-level"> <option label="Low level, light walking" value="low-level-light-walking">Low level, light walking</option> <option label="Moderate level - walking, light hiking, leisure biking" value="moderate-level-walking-light-hiking-leisure-biking">Moderate level - walking, light hiking, leisure biking</option> <option label="Active level - high energy - hiking, biking, kayaking, etc" value="active-level-high-energy-hiking-biking-kayaking-etc">Active level - high energy - hiking, biking, kayaking, etc</option> </field> <field type="radio-group" required="true" label="How important is nightly entertainment?" name="how-important-is-nightly-entertainment"> <option label="We would like lively entertainment most or every night" value="we-would-like-lively-entertainment-most-or-every-night">We would like lively entertainment most or every night</option> <option label="2 or 3 nights of lively entertainment are OK with us" value="2-or-3-nights-of-lively-entertainment-are-ok-with-us">2 or 3 nights of lively entertainment are OK with us</option> <option label="Lively entertainment is not important" value="lively-entertainment-is-not-important">Lively entertainment is not important</option> </field> <field type="radio-group" required="true" label="How important is it that the ship have bikes available for your use?" name="how-important-is-it-that-the-ship-have-bikes-available-for-guests-use"> <option label="A must" value="a-must">A must</option> <option label="It would be nice, but not necessary" value="it-would-be-nice-but-not-necessary">It would be nice, but not necessary</option> <option label="It is not important for our ship to offer the use of bikes" value="it-is-not-important-for-our-ship-to-offer-the-use-of-bikes">It is not important for our ship to offer the use of bikes</option> </field> <field type="radio-group" required="true" label="How interested are you in a "food and wine" themed cruise?" inline="true" name="how-interested-are-you-in-a-food-and-wine-themed-cruise"> <option label="Very interested" value="very-interested">Very interested</option> <option label="Somewhat interested" value="somewhat-interested">Somewhat interested</option> <option label="Indifferent/take it or leave it" value="indifferenttake-it-or-leave-it">Indifferent/take it or leave it</option> <option label="Not interested at all/avoid this theme" value="not-interested-at-allavoid-this-theme">Not interested at all/avoid this theme</option> </field> <field type="radio-group" required="true" label="How interested are you in a "gastronomy" themed cruise?" inline="true" name="how-interested-are-you-in-a-gastronomy-themed-cruise"> <option label="Very interested" value="very-interested">Very interested</option> <option label="Somewhat interested" value="somewhat-interested">Somewhat interested</option> <option label="Indifferent/take it or leave it" value="indifferenttake-it-or-leave-it">Indifferent/take it or leave it</option> <option label="Not interested at all/avoid this theme" value="not-interested-at-allavoid-this-theme">Not interested at all/avoid this theme</option> </field> <field type="radio-group" required="true" label="How interested are you in a "beer" themed cruise?" inline="true" name="how-interested-are-you-in-a-beer-themed-cruise"> <option label="Very interested" value="very-interested">Very interested</option> <option label="Somewhat interested" value="somewhat-interested">Somewhat interested</option> <option label="Indifferent/take it or leave it" value="indifferenttake-it-or-leave-it">Indifferent/take it or leave it</option> <option label="Not interested at all/avoid this theme" value="not-interested-at-allavoid-this-theme">Not interested at all/avoid this theme</option> </field> <field type="radio-group" required="true" label="How interested are you in "wellness" themed cruise?" inline="true" name="how-interested-are-you-in-wellness-themed-cruise"> <option label="Very interested" value="very-interested">Very interested</option> <option label="Somewhat interested" value="somewhat-interested">Somewhat interested</option> <option label="Indifferent/take it or leave it" value="indifferenttake-it-or-leave-it">Indifferent/take it or leave it</option> <option label="Not interested at all/avoid this theme" value="not-interested-at-allavoid-this-theme">Not interested at all/avoid this theme</option> </field> <field type="radio-group" required="true" label="How interested are you in "music" themed cruise?" inline="true" name="how-interested-are-you-in-music-themed-cruise"> <option label="Very interested" value="very-interested">Very interested</option> <option label="Somewhat interested" value="somewhat-interested">Somewhat interested</option> <option label="Indifferent/take it or leave it" value="indifferenttake-it-or-leave-it">Indifferent/take it or leave it</option> <option label="Not interested at all/avoid this theme" value="not-interested-at-allavoid-this-theme">Not interested at all/avoid this theme</option> </field> <field type="radio-group" required="true" label="How interested are you in seeing castles?" inline="true" name="how-interested-are-you-in-seeing-castles"> <option label="Very interested" value="very-interested">Very interested</option> <option label="Somewhat interested" value="somewhat-interested">Somewhat interested</option> <option label="Indifferent/take it or leave it" value="indifferenttake-it-or-leave-it">Indifferent/take it or leave it</option> <option label="Not interested at all/avoid this theme" value="not-interested-at-allavoid-this-theme">Not interested at all/avoid this theme</option> </field> <field type="textarea" required="true" label="List the following 8 items in order of importance starting with the most important:&nbsp; Quality of excursions, Quality of Meals, Nightly Entertainment, Onboard Activities, Beautiful Scenery, Service/Attentive Crew, Stateroom, Lively onboard Vibe" name="list-the-following-in-order-of-importance-starting-with-the-most-important-quality-of-excursions-meals-entertainment-scenery-servicecrew-stateroom-onboard-vibe" className="form-control"/> <field type="checkbox-group" label="Did you know you can do a river cruise on more than just European rivers? Please select which cruises interest you now or in the future. You may select more than one." name="did-you-know-you-can-do-a-river-cruise-in-more-than-just-europe-please-select-which-cruises-interest-you-now-or-in-the-future-you-may-select-more-than-one"> <option label="Mekong River, Vietnam and Cambodia" value="mekong-river-vietnam-and-cambodia">Mekong River, Vietnam and Cambodia</option> <option label="Chobe River, Africa" value="chobe-river-africa">Chobe River, Africa</option> <option label="Nile, Egypt" value="nile-egypt">Nile, Egypt</option> <option label="Magdalena River, Colombia" value="magdalena-river-colombia">Magdalena River, Colombia</option> <option label="Amazon, Peru" value="amazon-peru">Amazon, Peru</option> </field> <field type="text" label="If there is anything else that has not been covered on this form that you think would be helpful for me to know, please add it here." name="if-there-is-anything-else-that-has-not-been-covered-on-this-form-that-you-think-would-be-helpful-for-me-to-know-please-add-it-here" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Thank you for taking the time to complete this form! Your responses will be very helpful as we work together in finding the perfect river cruise experience for you. I will be in touch soon!"/> </fields> </form-template> </body> </html>
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