Share your information with
Melissa McGraw
Breakthrough Travel Co.
<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Let's Get You On Vacation!!!!!"/> <field type="paragraph" subtype="p" label="Hi! I'm Melissa McGraw and I would LOVE to help your family plan their next vacation!"/> <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!"/> <field type="header" subtype="h3" label="Full name"/> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field required="true" type="text" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <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"> <option label="Email" value="email">Email</option> <option label="Phone Call" value="phone-call">Phone Call</option> <option label="Text" value="text">Text</option> </field> <field type="checkbox-group" label="Where would you like to go?" name="where-would-you-like-to-go" other="true"> <option label="Walt Disney World in Florida" value="walt-disney-world-in-florida">Walt Disney World in Florida</option> <option label="Disneyland in California" value="disneyland-in-california">Disneyland in California</option> <option label="Disney Cruise" value="disney-cruise">Disney Cruise</option> <option label="Universal Studios Orlando" value="universal-studios-orlando">Universal Studios Orlando</option> <option label="Universal Studios Hollywood" value="universal-studios-hollywood">Universal Studios Hollywood</option> <option label="Aulani" value="aulani">Aulani</option> <option label="Adventures by Disney" value="adventures-by-disney">Adventures by Disney</option> <option label="Other Cruise Line" value="other-cruise-line">Other Cruise Line</option> <option label="All-Inclusive Resort" value="allinclusive-resort">All-Inclusive Resort</option> </field> <field type="text" label="When would you like to travel?&nbsp; If you are not sure of your exact dates, enter your month or approximate time you'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"/> <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"/> <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"/> <field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> </field> <field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="text" label="How many travelers?&nbsp; &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"/> <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.&nbsp; If you are interested in a cruise, please also provide the DOB of each traveler (including adults).&nbsp;" name="text-1768832607837" subtype="text" className="form-control"/> <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"> <option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option> <option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option> <option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option> <option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option> <option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option> <option label="$10,000+" value="10000">$10,000+</option> </field> <field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true"> <option label="Economy or Value" value="economy-or-value">Economy or Value</option> <option label="Moderate" value="moderate">Moderate</option> <option label="Luxury or Deluxe" value="luxury-or-deluxe">Luxury or Deluxe</option> <option label="Boutique" value="boutique">Boutique</option> </field> <field type="radio-group" label="Is separate sleep space amongst travel party important to you?&nbsp; Or is budget more important?&nbsp; This well help to direct standard room vs suite options.&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"> <option label="Must" value="must">Must</option> <option label="Nice to Have" value="nice-to-have">Nice to Have</option> <option label="Prioritize Budget" value="prioritize-budget">Prioritize Budget</option> </field> <field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option> <option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option> <option label="Party" value="party">Party</option> <option label="Local culture" value="local-culture">Local culture</option> <option label="Family friendly" value="family-friendly">Family friendly</option> <option label="Food and wine" value="food-wine">Food and wine</option> <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> <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> <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> </field> <field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true"> <option label="Beach or lake" value="beach-or-lake">Beach or lake</option> <option label="Pool" value="pool">Pool</option> <option label="Water Slide" value="water-slide">Water Slide</option> <option label="Splash Pad" value="splash-pad">Splash Pad</option> <option label="Spa (Hot Tub)" value="spa-hot-tub">Spa (Hot Tub)</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Scuba" value="scuba">Scuba</option> <option label="Adventure activities" value="adventure">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theater" value="art-theater">Arts and theater</option> <option label="Arcade " value="arcade-">Arcade </option> <option label="Playground" value="playground">Playground</option> <option label="Water Park" value="water-park">Water Park</option> <option label="Theme Park or Attractions" value="theme-park-or-attractions">Theme Park or Attractions</option> <option label="Other Organized Children's Activities" value="other-organized-childrens-activities">Other Organized Children's Activities</option> </field> <field type="checkbox-group" required="true" label="There are special discounts for certain groups.&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"> <option label="None" value="none">None</option> <option label="Active, Retired or 100% Disabled Military" value="active-retired-or-100-disabled-military">Active, Retired or 100% Disabled Military</option> <option label="Disney Chase Visa Cardholder" value="disney-chase-visa-cardholder">Disney Chase Visa Cardholder</option> <option label="DVC Member" value="dvc-member">DVC Member</option> <option label="Florida Resident (Walt Disney World)" value="florida-resident-walt-disney-world">Florida Resident (Walt Disney World)</option> <option label="Annual Passholder" value="annual-passholder">Annual Passholder</option> <option label="California Resident (Disneyland)" value="california-resident-disneyland">California Resident (Disneyland)</option> <option label="Active Disney+ Subscription" value="active-disney-subscription">Active Disney+ Subscription</option> <option label="Canadian Resident" value="canadian-resident">Canadian Resident</option> </field> <field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/> <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"/> <field type="text" label="How did you hear about me?" name="how-did-you-hear-about-me" subtype="text" className="form-control"/> <field type="text" label="Text Field" name="text-1768832766568" subtype="text" className="form-control"/> </fields> </form-template> </body> </html>
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