Share your information with Jessica Smith

Jessica Smith

Free to Dream Travel

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact 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" 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="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="text" required="true" label="What destination would you like to visit?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many adults/children are in your travel party? Please list children&#39;s ages at the time of travel." name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="When is the last time you visited this destination?" name="when-is-the-last-time-you-visited-this-destination">&#13;
			<option label="Never" value="never">Never</option>&#13;
			<option label="Within the last 2 years" value="within-the-last-2-years">Within the last 2 years</option>&#13;
			<option label="2-5 years ago" value="25-years-ago">2-5 years ago</option>&#13;
			<option label="5-10 years ago" value="510-years-ago">5-10 years ago</option>&#13;
			<option label="Over 10 years ago" value="over-10-years-ago">Over 10 years ago</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers (excluding airfare)?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$1,500 to $3,000" value="1500-to-3000">$1,500 to $3,000</option>&#13;
			<option label="$3,000 to $5,000" value="3000-to-5000">$3,000 to $5,000</option>&#13;
			<option label="$5,000 to $8,000" value="5000-to-8000">$5,000 to $8,000</option>&#13;
			<option label="$8,000 to $10,000" value="8000-to-10000">$8,000 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Deluxe" value="deluxe">Deluxe</option>&#13;
			<option label="Moderate" value="moderate" selected="selected">Moderate</option>&#13;
			<option label="Value" value="value">Value</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have a resort preference?" name="do-you-have-a-resort-preference" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What are your vacation must-do&#39;s and must-haves?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What are you most excited about for your vacation?" name="what-are-you-most-excited-about-for-your-vacation" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What are you most nervous about for your vacation?" name="what-are-you-most-nervous-about-for-your-vacation" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Please include any additional information that will help me customize your vacation package." description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Disney Destinations Only"/>&#13;
		<field type="paragraph" subtype="p" label="Please complete the following section only if you are planning to visit a Disney theme park."/>&#13;
		<field type="text" label="How many days would you like to spend in the parks?&amp;nbsp;" name="how-many-days-would-you-like-to-spend-in-the-parks-" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Walt Disney World - Which parks would you like to visit on your trip?" name="which-parks-would-you-like-to-visit-on-your-trip">&#13;
			<option label="Magic Kingdom" value="magic-kingdom">Magic Kingdom</option>&#13;
			<option label="Epcot" value="epcot">Epcot</option>&#13;
			<option label="Hollywood Studios" value="hollywood-studios">Hollywood Studios</option>&#13;
			<option label="Animal Kingdom" value="animal-kingdom">Animal Kingdom</option>&#13;
			<option label="I'm not sure yet" value="im-not-sure-yet">I'm not sure yet</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Disneyland - Which parks would you like to visit on your trip?" name="checkbox-group-1754484040669">&#13;
			<option label="Disneyland" value="disneyland">Disneyland</option>&#13;
			<option label="Disney California Adventure" value="disney-california-adventure">Disney California Adventure</option>&#13;
			<option label="I'm not sure yet" value="im-not-sure-yet">I'm not sure yet</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are you interested in adding the Disney Dining Plan to your vacation package? (Walt Disney World Only)" name="are-you-interested-in-adding-the-disney-dining-plan-to-your-vacation-package">&#13;
			<option label="Yes, the Disney Dining Plan" value="yes-the-disney-dining-plan">Yes, the Disney Dining Plan</option>&#13;
			<option label="Yes, the Disney Quick Service Dining Plan" value="yes-the-disney-quick-service-dining-plan">Yes, the Disney Quick Service Dining Plan</option>&#13;
			<option label="Yes, but I don't know which plan and would like more info" value="yes-but-i-dont-know-which-plan-and-would-like-more-info">Yes, but I don't know which plan and would like more info</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are you interested in adding the Park Hopper option to your theme park tickets?" name="radio-group-1754484165822">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Disney requires a $200 deposit. The balance of your trip is due in full 30 days before you travel. Are you able to make the $200 deposit at the time of your booking?" name="disney-requires-a-200-deposit-the-balance-of-your-trip-is-due-in-full-30-days-before-you-travel-are-you-able-to-make-the-200-deposit-at-the-time-of-your-booking">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Cruises Only"/>&#13;
		<field type="paragraph" subtype="p" label="Please complete the following section only if you are planning to cruise."/>&#13;
		<field type="radio-group" label="What cruise line would you like to sail?" name="what-cruise-line-would-you-like-to-sail" other="true">&#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="Norwegian Cruise Line" value="norwegian-cruise-line">Norwegian Cruise Line</option>&#13;
			<option label="Virgin Voyages (Adults Only)" value="virgin-voyages-adults-only">Virgin Voyages (Adults Only)</option>&#13;
			<option label="I need help deciding" value="i-need-help-deciding">I need help deciding</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Do all guests in your party have a valid US Passport?" name="do-all-guests-in-your-party-have-a-valid-us-passport">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="How many nights do you want to cruise?" name="how-many-nights-do-you-want-to-cruise" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Do you have a specific itinerary you are interested in?" name="do-you-have-a-specific-itinerary-you-are-interested-in" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Do you have a stateroom preference?" name="do-you-have-a-stateroom-preference">&#13;
			<option label="Suite Stateroom" value="suite-stateroom">Suite Stateroom</option>&#13;
			<option label="Verandah Stateroom" value="verandah-stateroom">Verandah Stateroom</option>&#13;
			<option label="Oceanview Stateroom" value="oceanview-stateroom">Oceanview Stateroom</option>&#13;
			<option label="Interior Stateroom" value="interior-stateroom">Interior Stateroom</option>&#13;
			<option label="I'm not sure" value="im-not-sure">I'm not sure</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Universal Only"/>&#13;
		<field type="text" label="How many days would you like to spend in the parks?&amp;nbsp;" name="text-1754484395193" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Which parks would you like to visit on your trip?" name="checkbox-group-1754484407980">&#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 yet" value="im-not-sure-yet">I'm not sure yet</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Are you interested in any of the following ticket add-ons?" name="checkbox-group-1754484496549">&#13;
			<option label="Park-to-Park - Visit more than one park in a day" value="parktopark-visit-more-than-one-park-in-a-day">Park-to-Park - Visit more than one park in a day</option>&#13;
			<option label="Express Pass" value="express-pass">Express Pass</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
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