Share your information with Keeley Wilson

Keeley Wilson

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Personalized Trip Proposal"/>&#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 required="true"  type="text" 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="checkbox-group" required="true" label="Preferred Method of Contact" name="preferred-method-of-contact">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Where would you like to go on your next adventure?" name="where-would-you-like-to-go-on-your-next-adventure">&#13;
			<option label="Walt Disney World" value="walt-disney-world">Walt Disney World</option>&#13;
			<option label="Disneyland" value="disneyland">Disneyland</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Aulani, A Disney Resort &amp; Spa" value="aulani-a-disney-resort-spa">Aulani, A Disney Resort &amp; Spa</option>&#13;
			<option label="Universal Studios Orlando" value="universal-studios-orlando">Universal Studios Orlando</option>&#13;
			<option label="Universal Studios Hollywood" value="universal-studios-hollywood">Universal Studios Hollywood</option>&#13;
			<option label="All-Inclusive Resort" value="allinclusive-resort">All-Inclusive Resort</option>&#13;
			<option label="Cruise (Royal Caribbean, Virgin, etc.)" value="cruise-royal-caribbean-virgin-etc">Cruise (Royal Caribbean, Virgin, etc.)</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="date" label="Desired Check-In Date" name="desired-checkin-date" className="form-control"/>&#13;
		<field type="date" label="Desired Check-Out Date" name="desired-checkout-date" className="form-control"/>&#13;
		<field type="textarea" label="Please provide the first and last names of all travelers, as well as the ages of anyone under 18" name="please-provide-the-first-and-last-names-of-all-travelers-as-well-as-the-ages-of-anyone-under-18" className="form-control"/>&#13;
		<field type="checkbox-group" label="What is your ideal budget?" name="what-is-your-ideal-budget">&#13;
			<option label="$2,500 or less" value="2500-or-less">$2,500 or less</option>&#13;
			<option label="$2,500 to $4,500" value="2500-to-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-to-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 or more" value="6500-or-more">$6,500 or more</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="In order to get the most accurate pricing, how soon are you looking to book?" name="in-order-to-get-the-most-accurate-pricing-how-soon-are-you-looking-to-book">&#13;
			<option label="As soon as possible" value="as-soon-as-possible">As soon as possible</option>&#13;
			<option label="Within the next month" value="within-the-next-month">Within the next month</option>&#13;
			<option label="Sometime in the next year" value="sometime-in-the-next-year">Sometime in the next year</option>&#13;
			<option label="Not ready to book, just looking for general pricing" value="not-ready-to-book-just-looking-for-general-pricing">Not ready to book, just looking for general pricing</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Do you qualify for any of these potential discounts?" name="do-you-qualify-for-any-of-these-potential-discounts">&#13;
			<option label="Florida Resident" value="florida-resident">Florida Resident</option>&#13;
			<option label="Disney Chase Visa Cardholder" value="disney-chase-visa-cardholder">Disney Chase Visa Cardholder</option>&#13;
			<option label="Military (active, retired, or 100% disabled)" value="military-active-retired-or-100-disabled">Military (active, retired, or 100% disabled)</option>&#13;
			<option label="Annual Passholder" value="annual-passholder">Annual Passholder</option>&#13;
			<option label="Disney+ Subscriber" value="disney-subscriber">Disney+ Subscriber</option>&#13;
		</field>&#13;
		<field type="text" label="Are you celebrating anything special?" name="are-you-celebrating-anything-special" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="In order to help make this trip as magical as possible, please let me know of any details or special requests below" name="in-order-to-help-make-this-trip-as-magical-as-possible-please-let-me-know-of-any-details-or-special-requests-below" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>