Share your information with Randall Beckett

Randall Beckett

Bethany Tours

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="The West Coast Tour - Inquiry Form"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name (As shown on passport)" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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="Email" name="email" 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="radio-group" label="What is your gender?" name="what-is-your-gender">&#13;
			<option label="Male" value="male">Male</option>&#13;
			<option label="Female" value="female">Female</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" label="Inquiry Date&amp;nbsp;" name="date-1753442335188" className="form-control"/>&#13;
		<field type="date" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel details"/>&#13;
		<field type="text" required="true" label="What is your departure city?" name="what-is-your-departure-city" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Departure date" name="departure-date" className="form-control"/>&#13;
		<field type="date" required="true" label="Return Date" name="return-date" className="form-control"/>&#13;
		<field type="text" required="true" label="How many travelers?" name="how-many-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many adults? (18 and older)" name="how-many-adults-18-and-older" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many children and their age?" name="how-many-children-and-their-age" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Do you need airport transfer to and from your booked accommodation?" name="airport-transfer-to-and-from-accommodation-required-" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="The West Coast is about 2hrs drive from Cape Town - known for its scenic beauty, unique towns, and natural attractions. It encompasses a diverse landscape of beaches, fishing villages, nature reserves, and cultural sites. The area is also famous for its spring flower displays, dried fish, and activities like kite surfing and birdwatching.&amp;nbsp; When planning to explore Cirtusdal area like Stadsaal Caves, it&#39;s better to plan for 2 or 3 days stay." name="select-your-places-of-interest-or-any-activities-for-your-full-day-8hrs-cape-town-city-tour" other="true">&#13;
			<option label="West Coast National Park " value="west-coast-national-park-">West Coast National Park </option>&#13;
			<option label="Flower Route " value="flower-route-">Flower Route </option>&#13;
			<option label="West Coast Fossil Park " value="west-coast-fossil-park-">West Coast Fossil Park </option>&#13;
			<option label="!Khwa ttu - Khoi-San art " value="khwa-ttu-khoisan-art-">!Khwa ttu - Khoi-San art </option>&#13;
			<option label="Langebaan " value="langebaan-">Langebaan </option>&#13;
			<option label="Namaqua National Park " value="namaqua-national-park-">Namaqua National Park </option>&#13;
			<option label="Citrusdal - Stadsaal Caves" value="citrusdal-stadsaal-caves">Citrusdal - Stadsaal Caves</option>&#13;
			<option label="Bird Watching " value="bird-watching-">Bird Watching </option>&#13;
			<option label="Atlantis Dunes - Quad Bikes, 4x4 and Sand Boarding" value="atlantis-dunes-quad-bikes-4x4-and-sand-boarding">Atlantis Dunes - Quad Bikes, 4x4 and Sand Boarding</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="checkbox-group" label="Vibe preferences" 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="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;
			<option label="Multi-generational" value="multi-generational">Multi-generational</option>&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>