Share your information with Neal Pyszka

Neal Pyszka

PKD Travel Pro

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Questions for your trip"/>&#13;
		<field type="radio-group" label="What type of travel?" name="type-of-vacation-inquiry">&#13;
			<option label="Cruise Travel" value="cruise-travel">Cruise Travel</option>&#13;
			<option label="Theme Park Vacation" value="theme-park-vacation">Theme Park Vacation</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="date" label="Travel Start Date" name="travel-start-date" className="form-control"/>&#13;
		<field type="date" label="Travel End Date" name="travel-end-date" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="select" label="Are your dates flexible?" name="select-1767561995918" className="form-control">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="What is your departure city?" name="text-1767562079199" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many travelers?" name="text-1767562111127" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget for all travelers?" name="radio-group-1767562155873">&#13;
			<option label="$1,500 to $2,500" value="1500-to-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-to-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-to-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-to-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-to-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What Cruise Line is your preference?" name="radio-group-1767562297045">&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Carnival Cruise Line" value="carnival-cruise-line">Carnival Cruise Line</option>&#13;
			<option label="Norwegian Cruise Line" value="norwegian-cruise-line">Norwegian Cruise Line</option>&#13;
			<option label="Celebrity Cruise Line" value="celebrity-cruise-line">Celebrity Cruise Line</option>&#13;
			<option label="Princess Cruise Line" value="princess-cruise-line">Princess Cruise Line</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="radio-group-1767562420028">&#13;
			<option label="Economy" value="economy">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What kind of bie are you looking for?" name="radio-group-1767562487090">&#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="Party" value="party">Party</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-and-wine">Food and Wine</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="text-1767562583548" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What else would you like me to know?" name="text-1767562627092" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Prefix" name="text-1767562685894" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" 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" label="Suffix" name="text-1767562709457" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="text-1767562726714" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How did you hear about&amp;nbsp; PKD Travel Pro?" name="how-did-you-hear-about-pkd-travel-pro" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>