Share your information with Leslie Kaczanowski

Leslie Kaczanowski

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Universal Orlando Vacation Request"/>&#13;
		<field type="paragraph" subtype="p" label="Thank you so much for choosing me to help book your Universal vacation getaway!&amp;nbsp; My average proposal turn around is 72 business hours. Please feel free to email me at any time with any questions! lesliekaczanowski@travelmation.net. I cannot wait to start planning your vacation! *Filling out this form will automatically include you in my monthly newsletter email, if you wish to opt out, please say so in the comments at the bottom. "/>&#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="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" 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" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Do you have accessibility needs?" name="do-you-have-accessibility-needs">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="Accessibility needs information " description="If Yes  please give me a little information to help me best serve you  If no feel free to skip :)" name="accessibility-needs-information-" className="form-control"/>&#13;
		<field type="date" required="true" label="When you would like to depart?" description="This can be changed if needed later." name="what-is-your-departure-date" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" name="what-is-your-return-date" className="form-control"/>&#13;
		<field type="select" required="true" label="Are your dates flexible?" name="are-your-dates-flexible" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="If yes, Please tell me what month/time frame you are able to depart and return. " description="I.e. We can travel any 7 nights between Oct 15th and Nov 22nd" name="if-yes-please-tell-me-what-monthtime-frame-you-are-able-to-depart-and-return-" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Will you require airfare?" name="will-you-require-airfare" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="We are booking our own airfare" value="we-are-booking-our-own-airfare">We are booking our own airfare</option>&#13;
		</field>&#13;
		<field type="text" label="If yes, What airport are you departing from?" name="if-yes-what-airport-are-you-departing-from" subtype="text" className="form-control"/>&#13;
		<field type="text" label="If yes, do you have a preferred airline?" name="if-yes-do-you-have-a-preferred-airline" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many travelers in your party?" name="how-many-travelers-in-your-party" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Would you like to stay on Universal Property?" description="Universal does an amazing job with theming and the accommodations are great on property! Not to mention transportation to and from the parks!" name="would-you-like-to-stay-on-universal-property" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="If yes, which type of resort best fits your preference? Select all that apply" name="if-yes-which-type-of-resort-best-fits-your-preference-select-all-that-apply">&#13;
			<option label="Value Inns and Suites" value="value-inns-and-suites">Value Inns and Suites</option>&#13;
			<option label="Prime Value" value="prime-value">Prime Value</option>&#13;
			<option label="Signature Collection" value="signature-collection">Signature Collection</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Which parks would you like to visit?" name="which-parks-would-you-like-to-visit" multiple="multiple" className="form-control">&#13;
			<option label="Universal Studios" value="universal-studios">Universal Studios</option>&#13;
			<option label="Islands Of Adventure" value="islands-of-adventure">Islands Of Adventure</option>&#13;
			<option label="Volcano Bay Universal Waterpark" value="">Volcano Bay Universal Waterpark</option>&#13;
			<option label="Universal's Epic Universe " value="universals-epic-universe-">Universal's Epic Universe </option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Which park ticket best fits your needs?&amp;nbsp;" description="I suggest the park to park ticket! To ride Hogwarts Express you MUST have a park to park ticket! If you want to add Universal&#39;s Epic Universe  AND visit the other parks  please also select one of the other park options as well!" name="select-1729192109189" multiple="multiple" className="form-control">&#13;
			<option label="1 park per day" value="1-park-per-day">1 park per day</option>&#13;
			<option label="Park to park ticket " value="park-to-park-ticket-">Park to park ticket </option>&#13;
		</field>&#13;
		<field type="select" label="How many park days would you like?" description="Most Common 3-4 Days" name="how-many-universal-park-days-would-you-like" className="form-control">&#13;
			<option label="10+" value="10">10+</option>&#13;
			<option label="7-10" value="710">7-10</option>&#13;
			<option label="4-6" value="46">4-6</option>&#13;
			<option label="3-4" value="34">3-4</option>&#13;
			<option label="1-2" value="12">1-2</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Would you like to add Halloween Horror Night Tickets?" description="This is valid between August 2024-October 2024." name="would-you-like-to-add-halloween-horror-night-tickets">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Tell Me More!" value="tell-me-more">Tell Me More!</option>&#13;
			<option label="Not Applicable For My Dates" value="not-applicable-for-my-dates">Not Applicable For My Dates</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="First and Last Names AND birth dates for all traveling individuals" name="names-and-birth-dates-of-all-traveling-individuals" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Budget total for all individuals" description="The total amount you would like to spend on the trip" name="budget-total-for-all-individuals" className="form-control">&#13;
			<option label="$4,500- $6,500" value="45006500">$4,500- $6,500</option>&#13;
			<option label="$2,500-$4,500" value="25004500">$2,500-$4,500</option>&#13;
			<option label="$6,500-$8,500" value="65008500">$6,500-$8,500</option>&#13;
			<option label="$8,500-$10,000" value="850010000">$8,500-$10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="text" label="What else would you like me to know?" name="what-else-would-you-like-me-to-know" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Who can I thank for referring you?" name="who-can-i-thank-for-referring-you" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>