Share your information with BEVERLY LABOMBARD

BEVERLY LABOMBARD

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="ROAM WITH BEV"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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 type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Bed preference" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="OCCUPANCY" name="occupancy" className="form-control">&#13;
			<option label="SINGLE" value="single">SINGLE</option>&#13;
			<option label="DOUBLE" value="double">DOUBLE</option>&#13;
			<option label="TRIPLE" value="triple">TRIPLE</option>&#13;
			<option label="QUAD" value="quad">QUAD</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="When do you want to travel (Dates)" name="when-do-you-want-to-travel-dates" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of Adults in your party" name="number-of-adults-in-your-party" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Number of Children in your party&amp;nbsp; AND we need thier age for proper quoting" name="number-of-children-in-your-party-and-we-need-thier-age-for-proper-quoting" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many rooms?&amp;nbsp; If more then one room please list out the number of adults and children / age in each room ." name="how-many-rooms-if-more-then-one-room-please-list-out-the-number-of-adults-and-children-age-in-each-room-" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Type of Hotel" name="type-of-cabin" className="form-control">&#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="Campground" value="campground">Campground</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Are you looking for a hotel that falls into one of these categories?" name="are-you-looking-for-a-hotel-that-falls-into-one-of-these-categories" className="form-control">&#13;
			<option label="on Monorail (access to Magic King &amp; Epcot) Deluxe Hotels Only" value="on-monorail-access-to-magic-king-epcot-deluxe-hotels-only">on Monorail (access to Magic King &amp; Epcot) Deluxe Hotels Only</option>&#13;
			<option label="on Skyliner (access to Epcot and Hollywood)  Deluxe, Moderate and Value" value="on-skyliner-access-to-epcot-and-hollywood-deluxe-moderate-and-value">on Skyliner (access to Epcot and Hollywood)  Deluxe, Moderate and Value</option>&#13;
			<option label="on Boat Route (access to Epcot &amp; Hollywood)   Deluxe Only on Boardwalk Hotels Only" value="on-boat-route-access-to-epcot-hollywood-deluxe-only-on-boardwalk-hotels-only">on Boat Route (access to Epcot &amp; Hollywood)   Deluxe Only on Boardwalk Hotels Only</option>&#13;
			<option label="on Boat Route (access to Disney Springs)  Moderate and Deluxe " value="on-boat-route-access-to-disney-springs-moderate-and-deluxe-">on Boat Route (access to Disney Springs)  Moderate and Deluxe </option>&#13;
			<option label="Best Value - less expenisve" value="best-value-less-expenisve">Best Value - less expenisve</option>&#13;
		</field>&#13;
		<field type="text" label="Do you know which hotel you would like to stay at?&amp;nbsp; If yes, list below&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp;&amp;nbsp;" name="do-you-know-which-hotel-you-would-like-to-stay-at-if-yes-list-below-" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="How Many Days would you like in the Parks (Magic Kingdom, Epcot, Animal Kingdom and Hollywood Studios)" name="how-many-days-would-you-like-in-the-parks-magic-kingdom-epcot-animal-kingdom-and-hollywood-studios" className="form-control">&#13;
			<option label="1 Day" value="1-day">1 Day</option>&#13;
			<option label="2 Day" value="2-day">2 Day</option>&#13;
			<option label="3 Day" value="3-day">3 Day</option>&#13;
			<option label="4 Day (recommended)" value="4-day-recommended">4 Day (recommended)</option>&#13;
			<option label="5 Day" value="5-day">5 Day</option>&#13;
			<option label="6 Day" value="6-day">6 Day</option>&#13;
			<option label="other" value="other">other</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Would you like to include Park Hopper (hop between parks)" description="Not recommended if you have little kiddos  we usually say after age 10 or older" name="would-you-like-to-include-park-hopper-hop-between-parks" className="form-control">&#13;
			<option label="Yes include Hopper Pass" value="yes-include-hopper-pass">Yes include Hopper Pass</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Dining Plan" name="dining-plan" className="form-control">&#13;
			<option label="Yes, Include Quick Service Plan" value="yes-include-quick-service-plan">Yes, Include Quick Service Plan</option>&#13;
			<option label="Yes, Include Table Service Plan" value="yes-include-table-service-plan">Yes, Include Table Service Plan</option>&#13;
			<option label="No Dining Plan Needed" value="no-dining-plan-needed">No Dining Plan Needed</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Memory Maker - includes all ride and professional photos throughout the parks and Disney Springs" name="memory-maker-includes-all-ride-and-professional-photos-throughout-the-parks-and-disney-springs" className="form-control">&#13;
			<option label="Yes, Include the discount memory maker in my quote" value="yes-include-the-discount-memory-maker-in-my-quote">Yes, Include the discount memory maker in my quote</option>&#13;
			<option label="No,  Thank You" value="no-thank-you">No,  Thank You</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What are some of your must do activities?&amp;nbsp; (Magic Kingdom Fireworks, Special Tours, Catarman Fireworks, Special Dining, Painting Class,&amp;nbsp; Hot AIr Balloon Ride,&amp;nbsp; Private Tours,&amp;nbsp; Etc)" name="what-are-some-of-your-must-do-activities-magic-kingdom-fireworks-special-tours-catarman-fireworks-special-dining-painting-class-hot-air-balloon-ride-private-tours-etc" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Special Needs&amp;nbsp; (Dietary, Medical)" name="other-comments-special-needs" className="form-control"/>&#13;
		<field type="textarea" label="Any Special Requests?" description="room away from elevator  higher floor  near your friends  not near your friends  etc" name="any-special-requests" className="form-control"/>&#13;
		<field type="text" label="Are you celebrating any special occassions?" name="are-you-celebrating-any-special-occassions" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Budget&amp;nbsp; Range" name="budget-range" className="form-control">&#13;
			<option label="$1000-$2000" value="10002000">$1000-$2000</option>&#13;
			<option label="$2000-$3000" value="20003000">$2000-$3000</option>&#13;
			<option label="$3000-$4000" value="30004000">$3000-$4000</option>&#13;
			<option label="$4000-$5000" value="40005000">$4000-$5000</option>&#13;
			<option label="$5000-$7000" value="50007000">$5000-$7000</option>&#13;
			<option label="$7000-$10000" value="700010000">$7000-$10000</option>&#13;
			<option label="Other please  list below in additional comments" value="other-please-list-below-in-additional-comments">Other please  list below in additional comments</option>&#13;
		</field>&#13;
		<field type="textarea" label="Additional Comments" name="additional-comments" className="form-control"/>&#13;
		<field type="select" required="true" label="DISCOUNTS" name="select-1734549034708" multiple="multiple" className="form-control">&#13;
			<option label="DVC" value="dvc">DVC</option>&#13;
			<option label="AP" value="ap">AP</option>&#13;
			<option label="DISNEY PLUS" value="disney-plus">DISNEY PLUS</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>