Share your information with Nikki Henry

Nikki Henry

Jetpack Getaways

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Quick Questions About Your Trip"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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="Suffix" name="suffix" 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="checkbox-group" required="true" label="Do you know when you want to travel?" name="do-you-know-when-you-want-to-travel">&#13;
			<option label="Yes, I know my travel dates, I will enter them below." value="yes-i-know-my-travel-dates-i-will-enter-them-below">Yes, I know my travel dates, I will enter them below.</option>&#13;
			<option label="No,  I need help deciding." value="no-i-need-help-deciding">No,  I need help deciding.</option>&#13;
		</field>&#13;
		<field type="textarea" label="Enter your travel dates or month you like to travel if you know them! Feel free to include as much details you know." name="notes" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Where do you want to go?" name="where-do-you-want-to-go">&#13;
			<option label="Walt Disney World " value="walt-disney-world-">Walt Disney World </option>&#13;
			<option label="Disneyland in California" value="disneyland-in-california">Disneyland in California</option>&#13;
			<option label="Disney Cruise" value="disney-cruise">Disney Cruise</option>&#13;
			<option label="Aulani" value="aulani">Aulani</option>&#13;
			<option label="Universal Studios Orlando" value="universal-studios-orlando">Universal Studios Orlando</option>&#13;
			<option label="Universal Studios Hollywood" value="universal-studios-hollywood">Universal Studios Hollywood</option>&#13;
			<option label="Royal Caribbean Cruise" value="royal-caribbean-cruise">Royal Caribbean Cruise</option>&#13;
			<option label="Carnival Cruise" value="carnival-cruise">Carnival 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="Domestic US Travel Destination" value="domestic-us-travel-destination">Domestic US Travel Destination</option>&#13;
			<option label="Other" value="">Other</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Who will be joining you on this trip? ( please include ages of children at the time of travel)" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your ideal budget? If unsure I can help you figure this out.&amp;nbsp;" name="text-1768182325715" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="If planning a Disney Vacation - There are special discounts for certain groups. Are you any of the below? Choose all that apply:" name="if-planning-a-disney-vacation-there-are-special-discounts-for-certain-groups-are-you-any-of-the-below-choose-all-that-apply">&#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 Cardholder" value="disney-chase-visa-cardholder">Disney Chase Visa Cardholder</option>&#13;
			<option label="DVC Member" value="dvc-member">DVC Member</option>&#13;
			<option label="Florida Resident ( Walt Disney World)" value="florida-resident-walt-disney-world">Florida Resident ( Walt Disney World)</option>&#13;
			<option label="Annual Passholder" value="annual-passholder">Annual Passholder</option>&#13;
			<option label="California Resident ( Disneyland)" value="california-resident-disneyland">California Resident ( Disneyland)</option>&#13;
			<option label="Active Disney+ Subscription" value="active-disney-subscription">Active Disney+ Subscription</option>&#13;
			<option label="Canadian Resident" value="canadian-resident">Canadian Resident</option>&#13;
		</field>&#13;
		<field type="text" label="How did you hear about me?" name="text-1768182368810" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Any other details I should know about your trip?" name="textarea-1768182789478" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>