Share your information with Emry Mills

Emry Mills

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Travel Inquiry Form"/>&#13;
		<field type="header" subtype="h3" label="Contact Information"/>&#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="header" subtype="h3" label="General Travel Questions&amp;nbsp;"/>&#13;
		<field type="text" label="Where would you like to go?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" 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;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Ages of each traveler at time of travel" name="text-1745782376382" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget overall?" 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="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="Sophisticated Decor" value="sophisticated-decor">Sophisticated Decor</option>&#13;
			<option label="Family Friendly" value="family-friendly">Family Friendly</option>&#13;
			<option label="Fun and Whimsical" value="fun-and-whimsical">Fun and Whimsical</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#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 Villa" value="deluxe-villa">Deluxe Villa</option>&#13;
		</field>&#13;
		<field type="text" label="Does anyone in your party have accessibility requirements?" name="text-1775620199559" subtype="text" className="form-control"/>&#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="Thrill Rides" value="thrill-rides">Thrill Rides</option>&#13;
			<option label="Family-friendly Attractions" value="familyfriendly-attractions">Family-friendly Attractions</option>&#13;
			<option label="Water Parks" value="water-parks">Water Parks</option>&#13;
			<option label="Disney History " value="disney-history-">Disney History </option>&#13;
			<option label="VIP Tours" value="vip-tours">VIP Tours</option>&#13;
			<option label="Character Dining" value="character-dining">Character Dining</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Shopping" value="shopping">Shopping</option>&#13;
			<option label="Fine dining" value="fine-dining">Fine dining</option>&#13;
			<option label="Shows &amp; Parades" value="shows-parades">Shows &amp; Parades</option>&#13;
			<option label="Nature" value="nature">Nature</option>&#13;
			<option label="Cultural Experiences" value="cultural-experiences">Cultural Experiences</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="header" subtype="h3" label="Disney &amp;amp; Universal Travelers&amp;nbsp;"/>&#13;
		<field type="text" label="How many days would you like to spend in theme parks?" name="text-1755992083631" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How much do you know about Disney and/or Universal?" name="radio-group-1764533714824">&#13;
			<option label="Nothing, I need all the help! " value="nothing-i-need-all-the-help-">Nothing, I need all the help! </option>&#13;
			<option label="A little bit, I could use some help" value="a-little-bit-i-could-use-some-help">A little bit, I could use some help</option>&#13;
			<option label="I'm a pro! " value="im-a-pro-">I'm a pro! </option>&#13;
			<option label="I am not vacationing to Disney or Universal this time" value="i-am-not-vacationing-to-disney-or-universal-this-time">I am not vacationing to Disney or Universal this time</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Are you interested in park hopping (multiple parks per day)?" name="checkbox-group-1767830115007">&#13;
			<option label="Yes!" value="yes">Yes!</option>&#13;
			<option label="No, just one park per day" value="no-just-one-park-per-day">No, just one park per day</option>&#13;
			<option label="I’m not sure! " value="im-not-sure-">I’m not sure! </option>&#13;
			<option label="I am booking a non theme park adventure" value="i-am-booking-a-non-theme-park-adventure">I am booking a non theme park adventure</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Tell me more!"/>&#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="pageBreak" name="pageBreak-1775615768382" next="Next" previous="Previous"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>