Share your information with Alison Goetz

Alison Goetz

Magic Mom Travel LLC

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Basic Information&amp;nbsp;"/>&#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="text" label="Preferred name" name="preferred-name" 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="textarea" required="true" label="Please list full legal names of each person in your travel party as they appear on a passport, driver&#39;s license, or birth certificate AND age at time of travel. If booking multiple rooms please group by room.&amp;nbsp;" description="Example : Room 1  : John Smith (36)  Jane Smith (36) Room 2: Rob Roy (38)  Robin Roy (37)  Robbie Roy (5)" name="please-list-full-legal-names-of-each-person-in-your-travel-party-as-they-appear-on-a-passport-drivers-license-or-birth-certificate-and-age-at-time-of-travel-if-booking-multiple-rooms-please-group-by-room-" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers NOT including flights?" name="what-is-your-budget-for-all-travelers-not-including-flights">&#13;
			<option label="$1,500 to $2,500 " value="1500-to-2500-">$1,500 to $2,500 </option>&#13;
			<option label="$2,500 to $5,000 " value="2500-to-5000-">$2,500 to $5,000 </option>&#13;
			<option label="$5,000 to $7,500" value="5000-to-7500">$5,000 to $7,500</option>&#13;
			<option label="$7,500 to $10,000" value="7500-to-10000">$7,500 to $10,000</option>&#13;
			<option label="$10,000 to $15,000" value="10000-to-15000">$10,000 to $15,000</option>&#13;
			<option label="$15,000+" value="15000">$15,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Is your budget flexible if it means taking the type of trip you prefer?" name="is-your-budget-flexible-if-it-means-taking-the-type-of-trip-you-prefer">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="date" required="true" label="When would you like to check in?" name="when-would-you-like-to-check-in" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to check out?" name="when-would-you-like-to-check-out" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are your travel dates flexible?" name="are-your-travel-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="If you answered YES above please note open date ranges below." name="if-you-answered-yes-above-please-note-open-date-ranges-below" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="When was the last time you traveled to Hawaii?" name="when-was-the-last-time-you-traveled-to-hawaii">&#13;
			<option label="In the past 3 years" value="in-the-past-3-years">In the past 3 years</option>&#13;
			<option label="3-5 years ago" value="35-years-ago">3-5 years ago</option>&#13;
			<option label="5-10 years ago " value="510-years-ago-">5-10 years ago </option>&#13;
			<option label="10+ years ago" value="10-years-ago">10+ years ago</option>&#13;
			<option label="I have never been " value="i-have-never-been-">I have never been </option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your room preference?" name="what-best-describes-your-room-preference">&#13;
			<option label="Standard Room ($$)" value="standard-room-">Standard Room ($$)</option>&#13;
			<option label="Deluxe Studio ($$)" value="deluxe-studio-">Deluxe Studio ($$)</option>&#13;
			<option label="Villa ($$$)" value="villa-">Villa ($$$)</option>&#13;
			<option label="Suite ($$$$$)" value="suite-">Suite ($$$$$)</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your view preference?" name="what-best-describes-your-view-preference">&#13;
			<option label="Standard ($)" value="standard-">Standard ($)</option>&#13;
			<option label="Island Garden View ($$)" value="island-garden-view-">Island Garden View ($$)</option>&#13;
			<option label="Poolside Garden View ($$$)" value="poolside-garden-view-">Poolside Garden View ($$$)</option>&#13;
			<option label="Partial Ocean View ($$$$)" value="partial-ocean-view-">Partial Ocean View ($$$$)</option>&#13;
			<option label="Ocean View ($$$$$)" value="ocean-view-">Ocean View ($$$$$)</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is most important to you about your accommodations?&amp;nbsp;" description="This could be preferred view  accessibility requests etc.." name="what-is-most-important-to-you-about-your-accommodations-are-there-any-sensory-or-mobility-restrictions-you-would-like-to-inform-me-of" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Are you celebrating anything on this trip?" name="are-you-celebrating-anything-on-this-trip" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Would you like to add a rental car?" name="would-you-like-to-add-a-rental-car">&#13;
			<option label="Yes " value="yes-">Yes </option>&#13;
			<option label="No " value="no-">No </option>&#13;
			<option label="Unsure" value="unsure">Unsure</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Would you like to add Travel Insurance to your vacation?" name="would-you-like-to-add-travel-insurance-to-your-vacation">&#13;
			<option label="Yes, please include it in my quotes" value="yes-please-include-it-in-my-quotes">Yes, please include it in my quotes</option>&#13;
			<option label="No, I do not wish to purchase travel insurance and assume all risks of that decision  " value="no-i-do-not-wish-to-purchase-travel-insurance-and-assume-all-risks-of-that-decision-">No, I do not wish to purchase travel insurance and assume all risks of that decision  </option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Have you used a travel agent in the past?" name="have-you-used-a-travel-agent-in-the-past">&#13;
			<option label="Yes " value="yes-">Yes </option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="What can I do to make your vacation planning a great experience?" name="what-can-i-do-to-make-your-vacation-planning-a-great-experience" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Which best describes your booking timeline?" name="which-best-describes-your-booking-timeline">&#13;
			<option label="I am ready to make my $400 deposit per room" value="i-am-ready-to-make-my-400-deposit-per-room">I am ready to make my $400 deposit per room</option>&#13;
			<option label="I will be ready in the next two weeks?" value="i-will-be-ready-in-the-next-two-weeks">I will be ready in the next two weeks?</option>&#13;
			<option label="I won't be ready for a month or more" value="i-wont-be-ready-for-a-month-or-more">I won't be ready for a month or more</option>&#13;
			<option label="I am just browsing " value="i-am-just-browsing-">I am just browsing </option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Where did you hear about our agency?" name="where-did-you-hear-about-our-agency" other="true">&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="LinkedIn" value="linkedin">LinkedIn</option>&#13;
			<option label="Google" value="google">Google</option>&#13;
			<option label="Travel Leaders" value="travel-leaders">Travel Leaders</option>&#13;
			<option label="Personal Referral" value="personal-referral">Personal Referral</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you belong to any of the following groups?" name="do-you-belong-to-any-of-the-following-groups">&#13;
			<option label="Repeat client" value="repeat-client">Repeat client</option>&#13;
			<option label="United States Armed Forces (Active Duty or Retired Veterans Only)" value="united-states-armed-forces-active-duty-or-retired-veterans-only">United States Armed Forces (Active Duty or Retired Veterans Only)</option>&#13;
			<option label="Disney Visa Rewards Cardholder" value="disney-visa-rewards-cardholder">Disney Visa Rewards Cardholder</option>&#13;
			<option label="Disney+ Subscriber" value="disney-subscriber">Disney+ Subscriber</option>&#13;
			<option label="Florida Resident" value="florida-resident">Florida Resident</option>&#13;
			<option label="California Resident" value="california-resident">California Resident</option>&#13;
			<option label="Hawaiian Resident " value="hawaiian-resident-">Hawaiian Resident </option>&#13;
			<option label="Canadian Resident" value="canadian-resident">Canadian Resident</option>&#13;
			<option label="UK Resident " value="uk-resident-">UK Resident </option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
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