Share your information with Joseph Haworth

Joseph Haworth

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Walt Disney World"/>&#13;
		<field type="checkbox-group" label="Have you been to Walt Disney World before?&amp;nbsp;" description="Have you visited the parks before" name="checkbox-group-1767545657286">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="date" label="What dates will you and your family be traveling to the Walt Disney World Resort?" 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 and your family be leaving Walt Disney World?" 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="text" label="Will you be flying or driving?&amp;nbsp;" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" 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;
		</field>&#13;
		<field type="radio-group" label="What Value resort are you interested in?" description="for example: What price category are you interested in" name="hotel-preference" other="true">&#13;
			<option label="Value" value="value">Value</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Deluxe" value="deluxe">Deluxe</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Which parks are most important to you?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Magic Kingdom" value="magic-kingdom">Magic Kingdom</option>&#13;
			<option label="Epcot" value="epcot">Epcot</option>&#13;
			<option label="Hollywood Studios" value="hollywood-studios">Hollywood Studios</option>&#13;
			<option label="Animal Kingdom" value="animal-kingdom">Animal Kingdom</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Are dining experiences important to you?" name="radio-group-1767546058658">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Any interest in character dining or signature restaurants?" name="select-1767546194802" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you want to stay on-property at a Disney resort or off-property?" name="radio-group-1767546842239">&#13;
			<option label="Disney resort" value="disney-resort">Disney resort</option>&#13;
			<option label="Off property" value="off-property">Off property</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Are you interested in extras like?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Dining Plans" value="dining-plans">Dining Plans</option>&#13;
			<option label="Special events (Mickeys Not-So-Scary halloween party, Jollywood nights) etc." value="special-events-mickeys-notsoscary-halloween-party-jollywood-nights-etc">Special events (Mickeys Not-So-Scary halloween party, Jollywood nights) etc.</option>&#13;
			<option label="Bibbidi Bobbidi Boutique" value="bibbidi-bobbidi-boutique">Bibbidi Bobbidi Boutique</option>&#13;
			<option label="Fireworks Dessert parties" value="fireworks-dessert-parties">Fireworks Dessert parties</option>&#13;
			<option label="Memory Maker (photos)" value="memory-maker-photos">Memory Maker (photos)</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you have a preferred theme or resort that you stayed at before?" name="radio-group-1767546912618" other="true">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Would you like park hopper tickets?" name="radio-group-1767547101605">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are you interested in Lightning Lane/Genie + options?" name="radio-group-1767547286542">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="How Many Park days are you planning?&amp;nbsp;" name="textarea-1767547032516" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What would make this the &quot;Perfect Disney Vacation&quot; for you?" name="textarea-1767547377131" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Would you like me to take care of everything from booking to planning, so all you have to do is enjoy the Magic?" name="radio-group-1767546716540">&#13;
			<option label="Yes Joe lets make it happen" value="yes-joe-lets-make-it-happen">Yes Joe lets make it happen</option>&#13;
			<option label="No I need more info " value="no-i-need-more-info-">No I need more info </option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Client information&amp;nbsp;"/>&#13;
		<field type="text" label="Prefix" name="prefix" 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="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>