Share your information with EmJay Rizzo

EmJay Rizzo

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Disney Vacation - Tell Me All The Magical Details!"/>&#13;
		<field type="date" 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" 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" 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" label="How many adult travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many children travelers? (include ages!)" name="text-1745625540687" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference">&#13;
			<option label="Value" value="value">Value</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Deluxe" value="deluxe">Deluxe</option>&#13;
			<option label="Deluxe Villas" value="deluxe-villas">Deluxe Villas</option>&#13;
			<option label="Other (Off Property)" value="other-off-property">Other (Off Property)</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Park Tickets" description="Check all that apply" name="activity-preferences">&#13;
			<option label="Base Tickets " value="base-tickets-">Base Tickets </option>&#13;
			<option label="Park Hopper" value="park-hopper">Park Hopper</option>&#13;
			<option label="Park Hopper plus option" value="park-hopper-plus-option">Park Hopper plus option</option>&#13;
		</field>&#13;
		<field type="radio-group" label="How many days are you going to a park?" name="radio-group-1745625707721">&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have any specific hotel(s) in mind?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Any other magical details I should know?&amp;nbsp;" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>