Share your information with Melissa McGraw

Melissa McGraw

Breakthrough Travel Co.

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Let&#39;s Get You On Vacation!!!!!"/>&#13;
		<field type="paragraph" subtype="p" label="Hi! I&#39;m Melissa McGraw and I would LOVE to help your family plan their next vacation!"/>&#13;
		<field type="paragraph" subtype="p" label="I do need a few details to get you on your magical, memory making  trip. My goal is to learn about you, your family and your goals for your trip so I can make the perfect recommendation and help you do your trip the right way!"/>&#13;
		<field type="header" subtype="h3" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-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" label="What is your preferred method of contact?" description="Choose all that apply" name="what-is-your-preferred-method-of-contact" other="true">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone Call" value="phone-call">Phone Call</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Where would you like to go?" name="where-would-you-like-to-go" other="true">&#13;
			<option label="Walt Disney World in Florida" value="walt-disney-world-in-florida">Walt Disney World in Florida</option>&#13;
			<option label="Disneyland in California" value="disneyland-in-california">Disneyland in California</option>&#13;
			<option label="Disney Cruise" value="disney-cruise">Disney Cruise</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="Aulani" value="aulani">Aulani</option>&#13;
			<option label="Adventures by Disney" value="adventures-by-disney">Adventures by Disney</option>&#13;
			<option label="Other Cruise Line" value="other-cruise-line">Other Cruise Line</option>&#13;
			<option label="All-Inclusive Resort" value="allinclusive-resort">All-Inclusive Resort</option>&#13;
		</field>&#13;
		<field type="text" label="When would you like to travel?&amp;nbsp; If you are not sure of your exact dates, enter your month or approximate time you&#39;d like to travel below. If you do know your exact dates, proceed to the next question!" name="if-you-are-not-sure-of-your-exact-dates-enter-your-month-or-approximate-time-youd-like-to-travel-below" subtype="text" className="form-control"/>&#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 travelers?&amp;nbsp; &amp;nbsp;Please list number of adults and children, and ages of each child at time of travel below:" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="If you would like me to be able to place a hold on a room when ready, please provide full names (and age for children) for each traveler below.&amp;nbsp; If you are interested in a cruise, please also provide the DOB of each traveler (including adults).&amp;nbsp;" name="text-1768832607837" 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" other="true">&#13;
			<option label="Economy or Value" value="economy-or-value">Economy or Value</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury or Deluxe" value="luxury-or-deluxe">Luxury or Deluxe</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Is separate sleep space amongst travel party important to you?&amp;nbsp; Or is budget more important?&amp;nbsp; This well help to direct standard room vs suite options.&amp;nbsp; Additionally, size of travel party may require multiple rooms and/or suite." name="is-separate-sleep-space-amongst-travel-party-important-to-you-or-is-budget-more-important-this-well-help-to-direct-standard-room-vs-suite-options-additionally-size-of-travel-party-may-require-multiple-rooms-andor-suite" other="true">&#13;
			<option label="Must" value="must">Must</option>&#13;
			<option label="Nice to Have" value="nice-to-have">Nice to Have</option>&#13;
			<option label="Prioritize Budget" value="prioritize-budget">Prioritize Budget</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
			<option label="For Disney: Over-the-top, bright, larger-than-life Disney theming; Food Court Only;" value="for-disney-overthetop-bright-largerthanlife-disney-theming-food-court-only">For Disney: Over-the-top, bright, larger-than-life Disney theming; Food Court Only;</option>&#13;
			<option label="For Disney: More subtle, detailed and relaxed theming; Quick-Service and Sit-Down Dining" value="for-disney-more-subtle-detailed-and-relaxed-theming-quickservice-and-sitdown-dining">For Disney: More subtle, detailed and relaxed theming; Quick-Service and Sit-Down Dining</option>&#13;
			<option label="For Disney:  Elegant, immersive, luxurious feel;  Some Quick-Service Dining but primarily Sit-Down Dining" value="for-disney-elegant-immersive-luxurious-feel-some-quickservice-dining-but-primarily-sitdown-dining">For Disney:  Elegant, immersive, luxurious feel;  Some Quick-Service Dining but primarily Sit-Down Dining</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach or lake" value="beach-or-lake">Beach or lake</option>&#13;
			<option label="Pool" value="pool">Pool</option>&#13;
			<option label="Water Slide" value="water-slide">Water Slide</option>&#13;
			<option label="Splash Pad" value="splash-pad">Splash Pad</option>&#13;
			<option label="Spa (Hot Tub)" value="spa-hot-tub">Spa (Hot Tub)</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
			<option label="Arcade " value="arcade-">Arcade </option>&#13;
			<option label="Playground" value="playground">Playground</option>&#13;
			<option label="Water Park" value="water-park">Water Park</option>&#13;
			<option label="Theme Park or Attractions" value="theme-park-or-attractions">Theme Park or Attractions</option>&#13;
			<option label="Other Organized Children's Activities" value="other-organized-childrens-activities">Other Organized Children's Activities</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="There are special discounts for certain groups.&amp;nbsp; Are you any of the below? Choose all that apply:" name="there-are-special-discounts-for-certain-groups-are-you-any-of-the-below-choose-all-that-apply">&#13;
			<option label="None" value="none">None</option>&#13;
			<option label="Active, Retired or 100% Disabled Military" value="active-retired-or-100-disabled-military">Active, Retired or 100% Disabled Military</option>&#13;
			<option label="Disney Chase Visa Cardholder" value="disney-chase-visa-cardholder">Disney Chase Visa Cardholder</option>&#13;
			<option label="DVC Member" value="dvc-member">DVC Member</option>&#13;
			<option label="Florida Resident (Walt Disney World)" value="florida-resident-walt-disney-world">Florida Resident (Walt Disney World)</option>&#13;
			<option label="Annual Passholder" value="annual-passholder">Annual Passholder</option>&#13;
			<option label="California Resident (Disneyland)" value="california-resident-disneyland">California Resident (Disneyland)</option>&#13;
			<option label="Active Disney+ Subscription" value="active-disney-subscription">Active Disney+ Subscription</option>&#13;
			<option label="Canadian Resident" value="canadian-resident">Canadian Resident</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" 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="text" label="How did you hear about me?" name="how-did-you-hear-about-me" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Text Field" name="text-1768832766568" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
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