Share your information with Nicole Teeter

Nicole Teeter

Blue Sapphire Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="You&#39;re Going on Vacation!"/>&#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" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" description="By providing your phone number  you agree to receive text messages from Mouse Counselors Travel. Reply STOP to opt-out of SMS messaging" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Communication Preference" name="communication-preference">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Vacation Destination" name="vacation-destination" other="true">&#13;
			<option label="Walt Disney World in Florida" value="walt-disney-world-in-florida">Walt Disney World in Florida</option>&#13;
			<option label="Disneyland in California" value="disneyland-in-california">Disneyland in California</option>&#13;
			<option label="Disney Cruise" value="disney-cruise">Disney Cruise</option>&#13;
			<option label="Universal Studios Orlando" value="universal-studios-orlando">Universal Studios Orlando</option>&#13;
			<option label="Universal Studios Hollywood" value="universal-studios-hollywood">Universal Studios Hollywood</option>&#13;
			<option label="Aulani" value="aulani">Aulani</option>&#13;
			<option label="Adventures by Disney" value="adventures-by-disney">Adventures by Disney</option>&#13;
			<option label="Other Cruise Line" value="other-cruise-line">Other Cruise Line</option>&#13;
			<option label="All Inclusive Resort" value="all-inclusive-resort">All Inclusive Resort</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Preferred Dates&amp;nbsp;" description="Can be exact dates or preferred month/year" name="preferred-dates-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of Adults Traveling&amp;nbsp;" name="number-of-adults-traveling-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of children traveling (list children&#39;s ages)" name="number-of-children-traveling-list-childrens-ages" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Let’s talk budget.&amp;nbsp;" description="This is just a guess on what you want to spend. I&#39;ll work with you to make sure we plan the trip you want around your ideal budget once we start working together. Having this info just gives us a good starting point." name="lets-talk-budget-" other="true">&#13;
			<option label="$2,500" value="2500">$2,500</option>&#13;
			<option label="$5,000" value="5000">$5,000</option>&#13;
			<option label="$7,500" value="7500">$7,500</option>&#13;
			<option label="$10,000" value="10000">$10,000</option>&#13;
			<option label="I have no idea what my budget is?" value="i-have-no-idea-what-my-budget-is">I have no idea what my budget is?</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="There are sometimes special discounts for certain groups. Are you any of the below? Choose all that apply:" name="checkbox-group-1764172127641">&#13;
			<option label="Active, Retired or 100% Disabled Military" value="active-retired-or-100-disabled-military">Active, Retired or 100% Disabled Military</option>&#13;
			<option label="Disney Chase Visa Cardholder" value="disney-chase-visa-cardholder">Disney Chase Visa Cardholder</option>&#13;
			<option label="DVC Member" value="dvc-member">DVC Member</option>&#13;
			<option label="Florida Resident (Walt Disney World)" value="florida-resident-walt-disney-world">Florida Resident (Walt Disney World)</option>&#13;
			<option label="Annual Passholder" value="annual-passholder">Annual Passholder</option>&#13;
			<option label="California Resident (Disneyland)" value="california-resident-disneyland">California Resident (Disneyland)</option>&#13;
			<option label="Active Disney+ Subscription" value="active-disney-subscription">Active Disney+ Subscription</option>&#13;
			<option label="Canadian Resident" value="canadian-resident">Canadian Resident</option>&#13;
			<option label="none" value="none">none</option>&#13;
		</field>&#13;
		<field type="text" label="Is there anything else you want me to know that would help me to better help you plan? Are you celebrating anything special?" name="is-there-anything-else-you-want-me-to-know-that-would-help-me-to-better-help-you-plan-are-you-celebrating-anything-special" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>