Share your information with Denise Kolanovic

Denise Kolanovic

A Dream & A Wish Travel Co.

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="I just need&amp;nbsp; a few details!"/>&#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="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Where would you like to travel to?" name="where-would-you-like-to-travel-to">&#13;
			<option label="Walt Disney World (Florida)" value="walt-disney-world-florida">Walt Disney World (Florida)</option>&#13;
			<option label="Disneyland (California)" value="disneyland-california">Disneyland (California)</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Universal Studios (Florida)" value="universal-studios-florida">Universal Studios (Florida)</option>&#13;
			<option label="Royal Caribbean Cruise" value="royal-caribbean-cruise">Royal Caribbean Cruise</option>&#13;
			<option label="Other Cruise Line" value="other-cruise-line">Other Cruise Line</option>&#13;
			<option label="All Inclusive Resort" value="all-inclusive-resort">All Inclusive Resort</option>&#13;
			<option label="Other Destination" value="other-destination">Other Destination</option>&#13;
		</field>&#13;
		<field type="textarea" label="Travel Dates (if you have specific dates in mindI will get you exact pricing. If you are not sure give me a general idea and we will work together to find the best options.)" name="travel-dates-if-you-have-specific-dates-in-mindi-will-get-you-exact-pricing-if-you-are-not-sure-give-me-a-general-idea-and-we-will-work-together-to-find-the-best-options" className="form-control"/>&#13;
		<field type="text" label="How many adults and/or children are traveling? (Please tell me children&#39;s ages at the time of travel)" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your resort budget?" name="what-is-your-resort-budget">&#13;
			<option label="$1,500 to $3,000" value="1500-to-3000">$1,500 to $3,000</option>&#13;
			<option label="$3,000 to $5,000" value="3000-to-5000">$3,000 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+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Do any of these discounts apply to you?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Active, Retired, or 100% Disabled Military" value="active-retired-or-100-disabled-military">Active, Retired, or 100% Disabled Military</option>&#13;
			<option label="Disney Chase Visa Card Holder" value="disney-chase-visa-card-holder">Disney Chase Visa Card Holder</option>&#13;
			<option label="Disney+ Subscriber " value="disney-subscriber-">Disney+ Subscriber </option>&#13;
			<option label="Annual Pass Holder" value="annual-pass-holder">Annual Pass Holder</option>&#13;
			<option label="Florida Resident" value="florida-resident">Florida Resident</option>&#13;
			<option label="California Resident" value="california-resident">California Resident</option>&#13;
		</field>&#13;
		<field type="text" label="Are you celebrating anything special?" 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;
		<field type="textarea" label="How did you hear about me?" name="how-did-you-hear-about-me" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
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