Share your information with Melinda Borczuch

Melinda Borczuch

Precious Petals Travel

<html>
  <body>
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	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" required="true" label="Bride/Groom/Partner #1" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Bride/Groom/Partner #2" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email Address" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Full Address" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone Number" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Preferred Method of Contact" name="checkbox-group-1781559521497">&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Have you selected a wedding date?&amp;nbsp;" name="checkbox-group-1781559583129">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Text Field" name="text-1781559645845" value="If yes, Wedding Date: " subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="checkbox-group-1781559588978">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Estimated Number of Guests" name="checkbox-group-1781559732462">&#13;
			<option label="Under 20" value="under-20" selected="selected">Under 20</option>&#13;
			<option label="20 - 40" value="20-40">20 - 40</option>&#13;
			<option label="40 - 60" value="40-60">40 - 60</option>&#13;
			<option label="60+" value="60">60+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Will children be attending?" name="checkbox-group-1781559800730">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Would you prefer:" name="checkbox-group-1781559833746">&#13;
			<option label="Adults Only" value="adults-only" selected="selected">Adults Only</option>&#13;
			<option label="Family Friendly" value="family-friendly">Family Friendly</option>&#13;
			<option label="Open to Both" value="open-to-both">Open to Both</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Destination Preferences:" name="checkbox-group-1781559887630">&#13;
			<option label="Cancun/Riviera Maya" value="cancunriviera-maya" selected="selected">Cancun/Riviera Maya</option>&#13;
			<option label="Costa Mujeres" value="costa-mujeres">Costa Mujeres</option>&#13;
			<option label="Punta Cana" value="punta-cana">Punta Cana</option>&#13;
			<option label="Jamaica" value="jamaica">Jamaica</option>&#13;
			<option label="Aruba" value="aruba">Aruba</option>&#13;
			<option label="St Lucia" value="st-lucia">St Lucia</option>&#13;
			<option label="Antigua" value="antigua">Antigua</option>&#13;
			<option label="Barbados" value="barbados">Barbados</option>&#13;
			<option label="Curacao" value="curacao">Curacao</option>&#13;
			<option label="Bahamas" value="bahamas">Bahamas</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" label="Text Field" name="text-1781560000146" value="If other . . what location? " subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Do you have a Resort in mind?" name="checkbox-group-1781560049977">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Text Field" name="text-1781560085076" value="If yes, which Resort? " subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="What is your approximate budget per couple (including airfare)" name="checkbox-group-1781560105146">&#13;
			<option label="Under $3000" value="under-3000" selected="selected">Under $3000</option>&#13;
			<option label="$3000 - $5000" value="3000-5000">$3000 - $5000</option>&#13;
			<option label="$5000 - $7000" value="5000-7000">$5000 - $7000</option>&#13;
			<option label="$7500+" value="7500">$7500+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Wedding Budget" name="checkbox-group-1781560181445">&#13;
			<option label="Under $5000" value="under-5000" selected="selected">Under $5000</option>&#13;
			<option label="$5000 - $10,000" value="5000-10000">$5000 - $10,000</option>&#13;
			<option label="$10,000 - $20,000" value="10000-20000">$10,000 - $20,000</option>&#13;
			<option label="$20,000+" value="20000">$20,000+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Wedding Vision" name="checkbox-group-1781560252443">&#13;
			<option label="Beach Ceremony" value="beach-ceremony" selected="selected">Beach Ceremony</option>&#13;
			<option label="Tropical Garden" value="tropical-garden">Tropical Garden</option>&#13;
			<option label="Elegant &amp; Luxurious" value="elegant-luxurious">Elegant &amp; Luxurious</option>&#13;
			<option label="Modern Chic" value="modern-chic">Modern Chic</option>&#13;
			<option label="Boho" value="boho">Boho</option>&#13;
			<option label="Intimate &amp; Romantic" value="intimate-romantic">Intimate &amp; Romantic</option>&#13;
			<option label="Fun &amp; Casual" value="fun-casual">Fun &amp; Casual</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What are the 3 most important things to you?" name="checkbox-group-1781560354211">&#13;
			<option label="Beautiful Beach" value="beautiful-beach" selected="selected">Beautiful Beach</option>&#13;
			<option label="Luxury Accomodations" value="luxury-accomodations">Luxury Accomodations</option>&#13;
			<option label="Great Food" value="great-food">Great Food</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Entertainment" value="entertainment">Entertainment</option>&#13;
			<option label="Wedding Package Value" value="wedding-package-value">Wedding Package Value</option>&#13;
			<option label="Group Perks" value="group-perks">Group Perks</option>&#13;
			<option label="Family Friendly Activities" value="family-friendly-activities">Family Friendly Activities</option>&#13;
			<option label="Adults Only" value="adults-only">Adults Only</option>&#13;
			<option label="Excursions &amp; Adventures" value="excursions-adventures">Excursions &amp; Adventures</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="In addition&amp;nbsp; - Would you like assistance with any of the following:" name="checkbox-group-1781560545494">&#13;
			<option label="Group Resort Accomodations" value="group-resort-accomodations" selected="selected">Group Resort Accomodations</option>&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Airport Transfers" value="airport-transfers">Airport Transfers</option>&#13;
			<option label="Excursions" value="excursions">Excursions</option>&#13;
			<option label="Honeymoon Planning" value="honeymoon-planning">Honeymoon Planning</option>&#13;
			<option label="Travel Insurance" value="travel-insurance">Travel Insurance</option>&#13;
		</field>&#13;
		<field type="textarea" label="Tell me about your Dream Destination Wedding" name="textarea-1781560735676" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Thank you for taking the time to complete this form! Once submitted, I&#39;ll review your information and schedule a complimentary consultation to discuss destination options, resort recommendations, guest accommodations, and next steps for planning your dream wedding."/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>