Share your information with Kim Denis

Kim Denis

Main Street Vacations ~ Consumer Protection License #85536

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Let&#39;s Start Planning!"/>&#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 required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Where would you like to go?" name="where-would-you-like-to-go" other="true">&#13;
			<option label="Disneyland , California" value="disneyland-california">Disneyland , California</option>&#13;
			<option label="Walt Disney World ,Florida" value="walt-disney-world-florida">Walt Disney World ,Florida</option>&#13;
			<option label="Disneyland Paris" value="disneyland-paris">Disneyland Paris</option>&#13;
			<option label="Aulani, Hawaii" value="aulani-hawaii">Aulani, Hawaii</option>&#13;
			<option label="Universal Orlando" value="universal-orlando">Universal Orlando</option>&#13;
			<option label="Universal Studios Hollywood" value="universal-studios-hollywood">Universal Studios Hollywood</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Other Cruise Line" value="other-cruise-line">Other Cruise Line</option>&#13;
			<option label="Rocky Mountaineer " value="rocky-mountaineer-">Rocky Mountaineer </option>&#13;
			<option label="Nickleodeon Resorts" value="nickleodeon-resorts">Nickleodeon Resorts</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have travel dates chosen?" name="do-you-have-travel-dates-chosen" subtype="text" 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;" description="Please include age of the kids at time of travel" name="number-of-travelers" subtype="text" className="form-control"/>&#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;
	</fields>&#13;
</form-template>
  </body>
</html>