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Travelmation LLC

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	<fields>&#13;
		<field type="paragraph" subtype="p" label="Thank you SO much for reaching out about planning your next cruise vacation! We look forward to working with you to create lasting memories for you and your family! Please fill out the questions below to help us get started with your trip. ***I do ask that if we work together, you book DIRECTLY with us and not on your own or through another travel agent. Our services are 100% free and does NOT cost you any extra on your total price. We are SO excited to plan with you and thank you again for choosing to support our small business!"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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" label="Preferred name" name="preferred-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="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="radio-group" required="true" label="Has your group traveled together before?" name="have-you-cruised-before">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#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="radio-group" label="Are your dates flexible?" 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" label="What port would you like to cruise from?" description="Cape Liberty  Nj or Manhattan, NY or Either" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Preferred Cruise destination(s)" name="preferred-cruise-destinations" other="true">&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Bermuda" value="bermuda">Bermuda</option>&#13;
			<option label="Bahamas" value="bahamas">Bahamas</option>&#13;
			<option label="Canada" value="canada">Canada</option>&#13;
		</field>&#13;
		<field type="radio-group" label="How many ports would you like to stop at?" name="how-many-ports-would-you-like-to-stop-at">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers will be cruising?" placeholder="Please indicate adults and children" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Approximately how many total rooms will be needed?" name="how-many-rooms-will-be-needed" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Approximately how many accessible cabins may be needed?" name="approximately-how-many-accessible-cabins-may-be-needed" 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;
			<option label="Prefer to discuss directly" value="prefer-to-discuss-directly">Prefer to discuss directly</option>&#13;
		</field>&#13;
		<field type="text" label="If you selected 10,000+ please share your approximate budget range:" name="if-10000-what-is-the-total-budget" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="How do you anticipate payment being handled for your group?" name="how-do-you-anticipate-payment-being-handled-for-your-group" other="true">&#13;
			<option label="Each traveler will pay separately" value="each-traveler-will-pay-separately">Each traveler will pay separately</option>&#13;
			<option label="One person will pay for the entire group" value="one-person-will-pay-for-the-entire-group">One person will pay for the entire group</option>&#13;
			<option label="Organization/Agency will be sponsoring the trip" value="organizationagency-will-be-sponsoring-the-trip">Organization/Agency will be sponsoring the trip</option>&#13;
			<option label="Unsure at this time" value="unsure-at-this-time">Unsure at this time</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you have a preferred Cruise Line?" name="do-you-have-a-preferred-cruise-line">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="If you answered YES to the question above, please list cruise line here!" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is most important on this Trip" name="what-is-most-important-on-this-trip">&#13;
			<option label="Accessibility" value="accessibility">Accessibility</option>&#13;
			<option label="Relaxation" value="relaxation">Relaxation</option>&#13;
			<option label="Excursions" value="excursions">Excursions</option>&#13;
			<option label="Entertainment" value="entertainment">Entertainment</option>&#13;
			<option label="Dining" value="dining">Dining</option>&#13;
			<option label="Family Activities" value="family-activities">Family Activities</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Accessibility Needs" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Wheelchair user" value="wheelchair-user">Wheelchair user</option>&#13;
			<option label="Scooter user" value="scooter-user">Scooter user</option>&#13;
			<option label="Walker/Cane" value="walkercane">Walker/Cane</option>&#13;
			<option label="Need Accessible Cabins/Roll in Shower" value="need-accessible-cabinsroll-in-shower">Need Accessible Cabins/Roll in Shower</option>&#13;
			<option label="Hearing Accessible Cabin" value="hearing-accessible-cabin">Hearing Accessible Cabin</option>&#13;
			<option label="Visual Alert Devices Needed" value="visual-alert-devices-needed">Visual Alert Devices Needed</option>&#13;
			<option label="Service Animal Traveling" value="service-animal-traveling">Service Animal Traveling</option>&#13;
			<option label="Special Dietary Needs" value="special-dietary-needs">Special Dietary Needs</option>&#13;
			<option label="Refrigeration for Medication" value="refrigeration-for-medication">Refrigeration for Medication</option>&#13;
			<option label="Other Medical Accommodations" value="other-medical-accommodations">Other Medical Accommodations</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are accessible shore excursions important to your group?" name="are-accessible-shore-excursions-important-to-your-group">&#13;
			<option label="Very Important" value="very-important">Very Important</option>&#13;
			<option label="Somewhat Important" value="somewhat-important">Somewhat Important</option>&#13;
			<option label="Not Important" value="not-important">Not Important</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Will Travelers require accessible transportation to/from the port?" name="will-travelers-require-accessible-transportation-tofrom-the-port">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Unsure" value="unsure">Unsure</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like us to know?" description="What else would you like us to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Thank you so much for taking the time to complete this form! If you need more information about a specific cruise line, please let us know and we can provide as much as necessary to plan the best trip! --Michelle and Amy"/>&#13;
	</fields>&#13;
</form-template>
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