Share your information with Priscilla Salmasi

Priscilla Salmasi

Travelmation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Cruise Quote Request"/>&#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" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Is this your first cruise?" name="is-this-your-first-trip-to-walt-disney-world">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="I've been before, but it's been a while!" value="ive-been-before-but-its-been-a-while">I've been before, but it's been a while!</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="How many adults (18+) are traveling in your party?" name="list-all-guests-and-their-age-at-the-time-of-travel" className="form-control"/>&#13;
		<field type="textarea" label="How many children? Skip if none." name="textarea-1734140820012" className="form-control"/>&#13;
		<field type="textarea" label="What are the ages of the children?" name="textarea-1743560472779" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Do you have any accessibility needs?" name="textarea-1739900915209" className="form-control"/>&#13;
		<field type="date" required="true" label="Start Date" name="start-date" className="form-control"/>&#13;
		<field type="date" required="true" label="End Date" name="end-date" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Length of Cruise" description="Magic Kingdom  Animal Kingdom  Epcot  Hollywood Studios  WaterParks" name="number-of-park-days">&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7+" value="7">7+</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="What ports are you interested in? What port do you want to sail out of?" name="textarea-1734559857385" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your budget?" description="Having this info just gives us a good starting point.  Families can expect to spend around $1 000/pp for a week-long Disney World vacation." name="radio-group-1734141002670">&#13;
			<option label="Under $3,000" value="under-3000">Under $3,000</option>&#13;
			<option label="$3,000- $4,500" value="3000-4500">$3,000- $4,500</option>&#13;
			<option label="$4,500 - $6,500" value="4500-6500">$4,500 - $6,500</option>&#13;
			<option label="$6,500 - $8,500" value="6500-8500">$6,500 - $8,500</option>&#13;
			<option label="$8,500 - $10,000" value="8500-10000">$8,500 - $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Are you driving or flying?" name="radio-group-1734141201315" other="true">&#13;
			<option label="Driving" value="driving">Driving</option>&#13;
			<option label="Flying" value="flying">Flying</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Which cruise line are you interested in?" name="which-resorts-are-you-interested-in-choose-up-to-3" other="true">&#13;
			<option label="Pick for me!" value="pick-for-me">Pick for me!</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Celebrity" value="celebrity">Celebrity</option>&#13;
			<option label="Carnival" value="carnival">Carnival</option>&#13;
			<option label="MSC" value="msc">MSC</option>&#13;
			<option label="Norweigan" value="norweigan">Norweigan</option>&#13;
			<option label="Virgin (adults only)" value="virgin-adults-only">Virgin (adults only)</option>&#13;
			<option label="Princess" value="princess">Princess</option>&#13;
			<option label="No preference " value="no-preference-">No preference </option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Which stateroom are you interested in?" name="checkbox-group-1750533232745">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="No preference" value="no-preference">No preference</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="There are special discounts for certain groups. Are you any of the below?" name="checkbox-group-1734141487356" other="true">&#13;
			<option label="Active or retired members of US Military" value="active-or-retired-members-of-us-military">Active or retired members of US Military</option>&#13;
			<option label="Fire/EMT" value="fireemt">Fire/EMT</option>&#13;
			<option label="Senior (55+)" value="senior-55">Senior (55+)</option>&#13;
			<option label="Disney Chase Visa Cardholder" value="disney-chase-visa-cardholder">Disney Chase Visa Cardholder</option>&#13;
		</field>&#13;
		<field type="textarea" label="If you chose &quot;Pick For Me&quot;, what are some of your interests?&amp;nbsp;" name="if-you-chose-pick-for-me-in-the-last-question-what-are-some-of-your-interests-any-favorite-characters-or-movies-the-more-information-you-share-the-better-job-i-can-do" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Do you want to add travel protection?" name="do-you-want-to-add-travel-protection">&#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="Any additional comments or questions? Use this space to elaborate on any answers to above questions. Anything else you want me to know? (Celebrations, special requests, etc)&amp;nbsp;" name="any-additional-comments-or-questions-use-this-space-to-elaborate-on-any-answers-to-above-questions" className="form-control"/>&#13;
		<field type="textarea" required="true" label="How did you hear about me?" name="textarea-1743560586580" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>