Share your information with Nikki Masson

Nikki Masson

Travelmation LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h3" label="Universal Orlando Trip Request"/>&#13;
		<field type="header" subtype="h1" label="Personal Information"/>&#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" label="Preferred name" name="preferred-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" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Address" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Names of everyone in travel party and BIRTHDAYS of Children." name="names-and-ages-of-children" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Trip Information"/>&#13;
		<field type="date" required="true" label="Check-In Date" name="checkin-date" className="form-control"/>&#13;
		<field type="date" required="true" label="Check-Out Date" name="checkout-date" className="form-control"/>&#13;
		<field type="text" label="Are these dates flexible? Please explain:" name="are-these-dates-flexible-please-explain" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Type of Resort you are interested in:&amp;nbsp;" name="type-of-resort-you-are-interested-in-">&#13;
			<option label="Value Resort" value="value-resort">Value Resort</option>&#13;
			<option label="Moderate Resort" value="moderate-resort">Moderate Resort</option>&#13;
			<option label="Deluxe Resort" value="deluxe-resort">Deluxe Resort</option>&#13;
			<option label="Club Level " value="club-level-">Club Level </option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="How many days of tickets are you interested in?&amp;nbsp;" name="how-many-days-of-tickets-are-you-interested-in-" other="true">&#13;
			<option label="2 Days" value="2-days">2 Days</option>&#13;
			<option label="3 Days" value="3-days">3 Days</option>&#13;
			<option label="4 Days" value="4-days">4 Days</option>&#13;
			<option label="5 Days" value="5-days">5 Days</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Which parks do you plan on going to?&amp;nbsp;" name="which-parks-do-you-plan-on-going-to-">&#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="EPIC Universe" value="epic-universe">EPIC Universe</option>&#13;
			<option label="Volcano Bay" value="volcano-bay">Volcano Bay</option>&#13;
			<option label="I'm not sure" value="im-not-sure">I'm not sure</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is your budget?" name="what-is-your-budget" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Will you fly or drive?" name="will-you-fly-or-drive">&#13;
			<option label="Drive" value="drive">Drive</option>&#13;
			<option label="Fly and I will take care of my airport transfers" value="fly-and-i-will-take-care-of-my-airport-transfers">Fly and I will take care of my airport transfers</option>&#13;
			<option label="Fly but I would like help booking transfers" value="fly-but-i-would-like-help-booking-transfers">Fly but I would like help booking transfers</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Are you interested in any extras?&amp;nbsp;" name="are-you-interested-in-any-extras-">&#13;
			<option label="Express Passes" value="express-passes">Express Passes</option>&#13;
			<option label="VIP Tour" value="vip-tour">VIP Tour</option>&#13;
		</field>&#13;
		<field type="textarea" label="Is this your first time? If you have been to Universal before please let me know where you stayed and what you enjoyed about it.&amp;nbsp;" name="is-this-your-first-time-if-you-have-been-to-disney-world-before-please-let-me-know-where-you-stayed-and-what-you-enjoyed-about-it-" className="form-control"/>&#13;
		<field type="textarea" label="Please let me know if there is anything else you would like me to know.&amp;nbsp;" name="please-let-me-know-if-there-is-anything-else-you-would-like-me-to-know-" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>