Share your information with Jamie Collins

Jamie Collins

Videre Travel

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	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Ahead of our complimentary consult, please complete this form so we can get right to the fun stuff on&amp;nbsp; our call!"/>&#13;
		<field type="header" subtype="h2" label="Full name and best contact phone number"/>&#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" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Do you prefer to communicate through phone calls, texts or email?&amp;nbsp;" name="do-you-prefer-to-communicate-through-phone-calls-texts-or-email-" 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" 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="checkbox-group" label="I would like my advisor to plan" name="checkbox-group-1775938812672">&#13;
			<option label="Hotels Only-Proposals &amp; Booking" value="hotels-onlyproposals-booking">Hotels Only-Proposals &amp; Booking</option>&#13;
			<option label="Moderate Comprehensive Itinerary - Hotels, Transfers, Experiences, etc" value="moderate-comprehensive-itinerary-hotels-transfers-experiences-etc">Moderate Comprehensive Itinerary - Hotels, Transfers, Experiences, etc</option>&#13;
		</field>&#13;
		<field type="text" label="If you are flying, where will you be departing from?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Your ideal room, view and bed configuration (this is important for families or multi-room trips)." name="your-ideal-room-view-and-bed-configuration-this-is-important-for-families-or-multiroom-trips" className="form-control"/>&#13;
		<field type="text" required="true" label="Names and relationships of each traveler (for children, please include ages)" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What is your ideal investment, not including airfare? Please specify a range or a maximum, not including airfare." name="text-1775950469480" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="What kind of vacation feel 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="Lively" value="lively">Lively</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 or Lake" value="beach-or-lake">Beach or Lake</option>&#13;
			<option label="Wellness &amp; Spa" value="wellness-spa">Wellness &amp; Spa</option>&#13;
			<option label="Theme Park" value="theme-park">Theme Park</option>&#13;
			<option label="Adventure/Sports " value="adventuresports-">Adventure/Sports </option>&#13;
			<option label="History" value="history">History</option>&#13;
			<option label="Food/Local Cuisine" value="foodlocal-cuisine">Food/Local Cuisine</option>&#13;
		</field>&#13;
		<field type="text" label="What type of accommodations do you prefer? 5 star luxury, 4 star local, boutique hotels, U.S. Based Chains, Villa/Home Rental, Other" name="text-1775930472305" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What hotels have you loved staying at in the past? What made them stand out to you?&amp;nbsp;" name="text-1775938024647" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="While we do not book air directly, we work with a wonderful airdesk that can assist with international air reservations. They charge an additional fee of $150 per ticket to book and manage your reservation. They provide 24/7 support in case of emergency or flight delays/cancellations. Do you want to work with the Air Desk or will you book your own flights?&amp;nbsp;" name="while-we-do-not-book-air-directly-we-work-with-a-wonderful-airdesk-that-can-assist-with-international-air-reservations-they-charge-an-additional-fee-of-150-per-ticket-to-book-and-manage-your-reservation-they-provide-247-support-in-case-of-emergency-or-flight-delayscancellations-do-you-want-to-work-with-the-air-desk-or-will-you-book-your-own-flights-">&#13;
			<option label="Air Desk" value="air-desk">Air Desk</option>&#13;
			<option label="On my own" value="on-my-own">On my own</option>&#13;
			<option label="TBD" value="tbd">TBD</option>&#13;
		</field>&#13;
		<field type="text" label="Any allergies, dietary restrictions, or mobility issues I need to be aware of for anyone in your traveling party?" name="meal-preference" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Can you confirm that all travelers have a current/unexpired passport with at least 6 months of eligibility from the end date of your trip*" name="can-you-confirm-that-all-travelers-have-a-currentunexpired-passport-with-at-least-6-months-of-eligibility-from-the-end-date-of-your-trip">&#13;
			<option label="Yes, I can confirm" value="yes-i-can-confirm">Yes, I can confirm</option>&#13;
			<option label="No, travelers will need to update their passports prior to travel" value="no-travelers-will-need-to-update-their-passports-prior-to-travel">No, travelers will need to update their passports prior to travel</option>&#13;
			<option label="We will not need passport for this vacation" value="we-will-not-need-passport-for-this-vacation">We will not need passport for this vacation</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Due to the nature of our business, we are not able to assist with accommodations that involve using hotel points and/or Amex points. Note, points or miles for flights are fine." name="checkbox-group-1775938359348">&#13;
			<option label="I understand and agree." value="i-understand-and-agree">I understand and agree.</option>&#13;
		</field>&#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="Videre Travel offers bespoke trip design, planning, and management services tailored to your needs. Our service fee starts at $100 for a hotel only proposal and up to $500 per trip for comprehensive itineraries. Custom itineraries include accommodations, transfers, experiences/tours, as well as countless smaller details. The magic lies in the way we pull all the parts of the itinerary together to ensure your trip is seamless and unforgettable. Please note that pricing is presented as a bundled rate and in most cases itemized pricing is not possible. Prices and availability are subject to change from original proposal to the time deposit is paid.&amp;nbsp;" name="checkbox-group-1775938453498">&#13;
			<option label="I understand and agree." value="i-understand-and-agree">I understand and agree.</option>&#13;
		</field>&#13;
	</fields>&#13;
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