Share your information with Cassie Ryker

Cassie Ryker

Pixie Travel Co.

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Disney Vacation Questionnaire&amp;nbsp;"/>&#13;
		<field type="header" subtype="h2" label="Name &amp;amp; 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 type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What is your departure city?" description="If flying  list the airport and preferred Airline" name="what-is-your-departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many people are going on this trip?" name="how-many-people-are-going-on-this-trip" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Are children going on this trip?" description="Under 18" name="radio-group-1768930626479">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1768930681116" rule="eyJ3aGVuRmllbGQiOiJyYWRpby1ncm91cC0xNzY4OTMwNjI2NDc5Iiwid2hlbkNvbmRpdGlvbiI6ImVxdWFscyIsIndoZW5WYWx1ZSI6InllcyIsInRoZW5BY3Rpb24iOiJzaG93IiwidGhlbkZpZWxkcyI6WyJwbGVhc2UtbGlzdC10aGUtY2hpbGRyZW5zLWFnZXMiXSwidGhlbkZpZWxkc0luZm8iOlt7Im5hbWUiOiJwbGVhc2UtbGlzdC10aGUtY2hpbGRyZW5zLWFnZXMiLCJsYWJlbCI6IlBsZWFzZSBsaXN0IHRoZSBjaGlsZHJlbidzIGFnZXMgYXQgdGltZSBvZiB0cmlwLiJ9XX0="/>&#13;
		<field type="text" label="Please list the children&#39;s ages at time of trip." name="please-list-the-childrens-ages" subtype="text" className="form-control field-hidden"/>&#13;
		<field type="pageBreak" name="pageBreak-1768929684383" next="Next" previous="Previous"/>&#13;
		<field type="header" subtype="h1" label="Trip Information"/>&#13;
		<field type="select" required="true" label="Which Disney Property would you like to visit?" name="which-disney-property-would-you-like-to-visit" className="form-control">&#13;
			<option label="Walt Disney World" value="walt-disney-world">Walt Disney World</option>&#13;
			<option label="Disneyland Anaheim" value="disneyland-anaheim">Disneyland Anaheim</option>&#13;
			<option label="Aulani Resort &amp; Spa" value="aulani-resort-spa">Aulani Resort &amp; Spa</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Adventures by Disney" value="adventures-by-disney">Adventures by Disney</option>&#13;
			<option label="International Disneyland" value="international-disneyland">International Disneyland</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1768929882343" rule="eyJ3aGVuRmllbGQiOiJ3aGljaC1kaXNuZXktcHJvcGVydHktd291bGQteW91LWxpa2UtdG8tdmlzaXQiLCJ3aGVuQ29uZGl0aW9uIjoiZXF1YWxzIiwid2hlblZhbHVlIjoiaW50ZXJuYXRpb25hbC1kaXNuZXlsYW5kIiwidGhlbkFjdGlvbiI6InNob3ciLCJ0aGVuRmllbGRzIjpbIndoaWNoLWludGVybmF0aW9uYWwtZGlzbmV5bGFuZC13b3VsZC15b3UtbGlrZS10by12aXNpdCJdLCJ0aGVuRmllbGRzSW5mbyI6W3sibmFtZSI6IndoaWNoLWludGVybmF0aW9uYWwtZGlzbmV5bGFuZC13b3VsZC15b3UtbGlrZS10by12aXNpdCIsImxhYmVsIjoiV2hpY2ggSW50ZXJuYXRpb25hbCBEaXNuZXlsYW5kIHdvdWxkIHlvdSBsaWtlIHRvIHZpc2l0PyJ9XX0="/>&#13;
		<field type="select" label="Which International Disneyland would you like to visit?" name="which-international-disneyland-would-you-like-to-visit" className="form-control field-hidden">&#13;
			<option label="Paris" value="paris">Paris</option>&#13;
			<option label="Tokyo" value="tokyo">Tokyo</option>&#13;
			<option label="Hong Kong" value="hong-kong">Hong Kong</option>&#13;
			<option label="Shanghai" value="shanghai">Shanghai</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1768930241432" rule="eyJ3aGVuRmllbGQiOiJ3aGljaC1kaXNuZXktcHJvcGVydHktd291bGQteW91LWxpa2UtdG8tdmlzaXQiLCJ3aGVuQ29uZGl0aW9uIjoiZXF1YWxzIiwid2hlblZhbHVlIjoiZGlzbmV5LWNydWlzZS1saW5lIiwidGhlbkFjdGlvbiI6InNob3ciLCJ0aGVuRmllbGRzIjpbInNlbGVjdC0xNzY4OTMwMjM4OTU3Il0sInRoZW5GaWVsZHNJbmZvIjpbeyJuYW1lIjoic2VsZWN0LTE3Njg5MzAyMzg5NTciLCJsYWJlbCI6IlNlbGVjdCJ9XX0="/>&#13;
		<field type="select" label="Which Destination Itinerary are you interested in?" name="select-1768930238957" multiple="multiple" className="form-control field-hidden">&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Bahamas" value="bahamas">Bahamas</option>&#13;
			<option label="Bermuda" value="bermuda">Bermuda</option>&#13;
			<option label="Canada" value="canada">Canada</option>&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="Hawai'i" value="hawaii">Hawai'i</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="New Zealand &amp; Australia" value="new-zealand-australia">New Zealand &amp; Australia</option>&#13;
			<option label="Pacific Coast" value="pacific-coast">Pacific Coast</option>&#13;
			<option label="Panama Canal" value="panama-canal">Panama Canal</option>&#13;
			<option label="Singapore" value="singapore">Singapore</option>&#13;
			<option label="South Pacific" value="south-pacific">South Pacific</option>&#13;
			<option label="Transatlantic" value="transatlantic">Transatlantic</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1768930945411" rule="eyJ3aGVuRmllbGQiOiJ3aGljaC1kaXNuZXktcHJvcGVydHktd291bGQteW91LWxpa2UtdG8tdmlzaXQiLCJ3aGVuQ29uZGl0aW9uIjoiZXF1YWxzIiwid2hlblZhbHVlIjoiYWR2ZW50dXJlcy1ieS1kaXNuZXkiLCJ0aGVuQWN0aW9uIjoic2hvdyIsInRoZW5GaWVsZHMiOlsid2hpY2gtZGVzdGluYXRpb25zLWFyZS15b3UtaW50ZXJlc3RlZC1pbi12aXNpdGluZyJdLCJ0aGVuRmllbGRzSW5mbyI6W3sibmFtZSI6IndoaWNoLWRlc3RpbmF0aW9ucy1hcmUteW91LWludGVyZXN0ZWQtaW4tdmlzaXRpbmciLCJsYWJlbCI6IldoaWNoIERlc3RpbmF0aW9ucyBhcmUgeW91IGludGVyZXN0ZWQgaW4gdmlzaXRpbmc/In1dfQ=="/>&#13;
		<field type="select" label="Which Destinations are you interested in visiting?" name="which-destinations-are-you-interested-in-visiting" multiple="multiple" className="form-control field-hidden">&#13;
			<option label="Africa" value="africa">Africa</option>&#13;
			<option label="Asia Pacific" value="asia-pacific">Asia Pacific</option>&#13;
			<option label="Central &amp; South Asia" value="central-south-asia">Central &amp; South Asia</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
			<option label="North America" value="north-america">North America</option>&#13;
			<option label="River Cruise" value="river-cruise">River Cruise</option>&#13;
			<option label="Escape" value="escape">Escape</option>&#13;
		</field>&#13;
		<field type="date" label="When would you like to arrive?" name="when-would-you-like-to-arrive" className="form-control"/>&#13;
		<field type="date" label="When would you like to depart?" name="when-would-you-like-to-depart" className="form-control"/>&#13;
		<field type="radio-group" label="Are these dates flexible?" name="radio-group-1768930072124">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="pageBreak" name="pageBreak-1768930138058" next="Next" previous="Previous"/>&#13;
		<field type="text" label="If you have a preferred hotel, please list it here." description="If wanting a cruise   list a preferred  ship/stateroom type." name="if-you-have-a-preferred-hotel-please-list-it-here" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget?" name="radio-group-1768930584751">&#13;
			<option label="Budget Friendly" value="budget-friendly">Budget Friendly</option>&#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="Unsure" value="unsure">Unsure</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1768931240236" rule="eyJ3aGVuRmllbGQiOiJ3aGljaC1kaXNuZXktcHJvcGVydHktd291bGQteW91LWxpa2UtdG8tdmlzaXQiLCJ3aGVuQ29uZGl0aW9uIjoiZXF1YWxzIiwid2hlblZhbHVlIjoiZGlzbmV5LWNydWlzZS1saW5lIiwidGhlbkFjdGlvbiI6InNob3ciLCJ0aGVuRmllbGRzIjpbImFyZS15b3UtaW50ZXJlc3RlZC1pbi1zaG9yZS1leGN1cnNpb25zIl0sInRoZW5GaWVsZHNJbmZvIjpbeyJuYW1lIjoiYXJlLXlvdS1pbnRlcmVzdGVkLWluLXNob3JlLWV4Y3Vyc2lvbnMiLCJsYWJlbCI6IkFyZSB5b3UgaW50ZXJlc3RlZCBpbiBzaG9yZSBleGN1cnNpb25zPyJ9XX0="/>&#13;
		<field type="radio-group" label="Are you interested in shore excursions?" name="are-you-interested-in-shore-excursions" className="field-hidden">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Maybe" value="maybe">Maybe</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1768931954366" rule="eyJ3aGVuRmllbGQiOiJ3aGljaC1kaXNuZXktcHJvcGVydHktd291bGQteW91LWxpa2UtdG8tdmlzaXQiLCJ3aGVuQ29uZGl0aW9uIjoiZXF1YWxzIiwid2hlblZhbHVlIjoid2FsdC1kaXNuZXktd29ybGQiLCJ0aGVuQWN0aW9uIjoic2hvdyIsInRoZW5GaWVsZHMiOlsiYXJlLXlvdS1pbnRlcmVzdGVkLWluLXRoZS1kaXNuZXktZGluaW5nLXBsYW4iXSwidGhlbkZpZWxkc0luZm8iOlt7Im5hbWUiOiJhcmUteW91LWludGVyZXN0ZWQtaW4tdGhlLWRpc25leS1kaW5pbmctcGxhbiIsImxhYmVsIjoiQXJlIHlvdSBpbnRlcmVzdGVkIGluIHRoZSBEaXNuZXkgRGluaW5nIFBsYW4/In1dfQ=="/>&#13;
		<field type="radio-group" label="Are you interested in the Disney Dining Plan?" name="are-you-interested-in-the-disney-dining-plan" className="field-hidden">&#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="checkbox-group" label="What is the most important aspect of this trip for your family?" description="Select as many that apply" name="what-is-the-most-important-aspect-of-this-trip-for-your-family" other="true">&#13;
			<option label="Food &amp; Drink" value="food-drink">Food &amp; Drink</option>&#13;
			<option label="Rides" value="rides">Rides</option>&#13;
			<option label="Family Time" value="family-time">Family Time</option>&#13;
			<option label="Exploration" value="exploration">Exploration</option>&#13;
			<option label="Character Meet &amp; Greets" value="character-meet-greets">Character Meet &amp; Greets</option>&#13;
			<option label="Pool Time" value="pool-time">Pool Time</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>