Share your information with Chelcie Beadnell

Chelcie Beadnell

Beadnell Travel

<html>
  <body>
    <form-template>
	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>
		<field type="header" subtype="h2" label="Full name"/>
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>
		<field type="header" subtype="h2" label="Address"/>
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>
		<field type="text" label="Country" name="address-country" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>
		<field type="header" subtype="h1" label="Basic Information"/>
		<field type="textarea" required="true" label="Please briefly summarize the trip you&#39;re planning." description="Please briefly summarize the trip you&#39;re planning." name="please-briefly-summarize-the-trip-youre-planning" className="form-control"/>
		<field type="text" required="true" label="What are you expected travel dates?" name="what-are-you-expected-travel-dates" subtype="text" className="form-control"/>
		<field type="text" required="true" label="What is your maximum expected budget?" name="what-is-your-maximum-expected-budget" subtype="text" className="form-control"/>
		<field type="textarea" required="true" label="Please list the first and last names and dates of birth for all travelers." name="please-list-the-first-and-last-names-and-dates-of-birth-for-all-travelers" className="form-control"/>
		<field type="header" subtype="h1" label="Disney Options"/>
		<field type="select" required="true" label="Do you want to stay at a Disney resort?" name="do-you-want-to-stay-at-a-disney-resort" className="form-control">
			<option label="Yes" value="yes">Yes</option>
			<option label="No" value="no">No</option>
			<option label="Unsure" value="unsure">Unsure</option>
		</field>
		<field type="text" label="If yes, please list your preferred resort and room type (if you know it)" name="if-yes-please-list-your-preferred-resort-and-room-type-if-you-know-it" subtype="text" className="form-control"/>
		<field type="text" label="Are there any restaurants that you&#39;d like to try to get a reservation at?&amp;nbsp; If so, please list them below." name="are-there-any-restaurants-that-youd-like-to-try-to-get-a-reservation-at-if-so-please-list-them-below" subtype="text" className="form-control"/>
		<field type="text" required="true" label="How many days would you like to spend in the parks?" name="how-many-days-would-you-like-to-spend-in-the-parks" subtype="text" className="form-control"/>
		<field type="checkbox-group" label="Which parks would you like to visit?" name="which-parks-would-you-like-to-visit">
			<option label="Magic Kingdom" value="magic-kingdom" selected="selected">Magic Kingdom</option>
			<option label="Animal Kingdom" value="animal-kingdom">Animal Kingdom</option>
			<option label="EPCOT" value="epcot">EPCOT</option>
			<option label="Hollywood Studios" value="hollywood-studios">Hollywood Studios</option>
			<option label="A non-Disney park (Universal, Sea World, etc)" value="a-nondisney-park-universal-sea-world-etc">A non-Disney park (Universal, Sea World, etc)</option>
		</field>
		<field type="select" required="true" label="Would you like standard or park hopper tickets?" name="would-you-like-standard-or-park-hopper-tickets" className="form-control">
			<option label="Yes" value="yes">Yes</option>
			<option label="No" value="no">No</option>
			<option label="Unsure" value="unsure">Unsure</option>
		</field>
		<field type="textarea" label="If there&#39;s anything else you&#39;d like us to know, please put it here" name="if-theres-anything-else-youd-like-us-to-know-please-put-it-here" className="form-control"/>
	</fields>
</form-template>
  </body>
</html>