Share your information with Nicole Welter

Nicole Welter

Lets Go Travel Agency

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		<field type="header" subtype="h2" label="Welcome to Lets Go Travel Agency&amp;nbsp; . . . where the Magic begins!"/>&#13;
		<field type="header" subtype="h3" label="Share magical memories at the place where dreams come true!"/>&#13;
		<field type="paragraph" subtype="p" label="Let’s get the Magic Started!   Simply fill out the form below as best you can. Required items are indicated with a * red asterisk .    If you would like to travel to Walt Disney World in 2027, please share as much information as you can about your possible travel plans in the following form.&amp;nbsp; Someone will reach out to you in 24-48 hours"/>&#13;
		<field type="select" label="Have you been to Walt Disney World before?" placeholder="-- Please Select --" name="been-to-wdw-before" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="This is my first Walt Disney World Vacation" value="This is my first Walt Disney World Vacation">This is my first Walt Disney World Vacation</option>&#13;
			<option label="I’ve been to Walt Disney World in the last 3 years" value="I’ve been to Walt Disney World in the last 3 years">I’ve been to Walt Disney World in the last 3 years</option>&#13;
			<option label="It’s been more than 3 years since I‘ve been to Walt Disney World" value="It’s been more than 3 years since I‘ve been to Walt Disney World">It’s been more than 3 years since I‘ve been to Walt Disney World</option>&#13;
		</field>&#13;
		<field type="select" label="Are you celebrating a special occasion?" placeholder="-- Please Select --" name="celebrating-special-occasion" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Birthday" value="Birthday">Birthday</option>&#13;
			<option label="Engagement" value="Engagement">Engagement</option>&#13;
			<option label="Wedding" value="Wedding">Wedding</option>&#13;
			<option label="Honeymoon" value="Honeymoon">Honeymoon</option>&#13;
			<option label="Anniversary" value="Anniversary">Anniversary</option>&#13;
			<option label="Family Reunion" value="Family Reunion">Family Reunion</option>&#13;
			<option label="Graduation" value="Graduation">Graduation</option>&#13;
			<option label="Other" value="Other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" label="Share what’s important to you on this vacation. What would make it special?" name="vacation-special-importance" rows="10" className="form-control"/>&#13;
		<field type="select" label="Have you booked with Lets Go Travel Agency before?" placeholder="-- Please Select --" name="booked-with-small-world-before" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Yes" value="Yes">Yes</option>&#13;
			<option label="No" value="No">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Time for the Magic!"/>&#13;
		<field type="paragraph" subtype="p" label="Lets Go Travel Agency Minimum Night Stay:&amp;nbsp; 3-night minimum: Disney Value Resort – Standard Room and 3+ days of Tickets&amp;nbsp; &amp;nbsp; &amp;nbsp;-&amp;nbsp; 3-night minimum:  Disney Moderate, Deluxe, Deluxe Villa, Family Suite, Cabin&amp;nbsp; &amp;nbsp;- 5-night minimum: Disney Value Resort - Standard Room Only – No Tickets "/>&#13;
		<field type="date" required="true" label="Possible 2027 Check-In Date" placeholder="mm/dd/yyyy" name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="Possible 2027 Check-Out Date" placeholder="mm/dd/yyyy" name="ending-at" className="form-control"/>&#13;
		<field type="select" label="Are your dates flexible by a day or two?" placeholder="-- Please Select --" name="dates-flexible" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Yes" value="Yes">Yes</option>&#13;
			<option label="No" value="No">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Possible Discounts"/>&#13;
		<field type="checkbox-group" label="Please let us know which of the following discounts you might be eligible for:" name="possible-discounts" className="checkbox-group">&#13;
			<option label="Annual Passholder" value="Annual Passholder">Annual Passholder</option>&#13;
			<option label="Disney Visa Cardholder" value="Disney Visa Cardholder">Disney Visa Cardholder</option>&#13;
			<option label="Disney+ Subscriber" value="Disney+ Subscriber">Disney+ Subscriber</option>&#13;
			<option label="Military - Active Duty or Retired US Military ID required" value="Military - Active Duty or Retired US Military ID required">Military - Active Duty or Retired US Military ID required</option>&#13;
			<option label="Florida Resident" value="Florida Resident">Florida Resident</option>&#13;
			<option label="Canadian Resident" value="Canadian Resident">Canadian Resident</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="My estimated TOTAL budget for all travelers without airfare" name="budget" className="radio-group">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Under $3000" value="Under $3000">Under $3000</option>&#13;
			<option label="$3000 - $4000" value="$3000 - $4000">$3000 - $4000</option>&#13;
			<option label="$4000 - $5000" value="$4000 - $5000">$4000 - $5000</option>&#13;
			<option label="$5000 - $6000" value="$5000 - $6000">$5000 - $6000</option>&#13;
			<option label="$6000 - $7000" value="$6000 - $7000">$6000 - $7000</option>&#13;
			<option label="$7000 - $8000" value="$7000 - $8000">$7000 - $8000</option>&#13;
			<option label="$8000 - $9000" value="$8000 - $9000">$8000 - $9000</option>&#13;
			<option label="$9000 - $10,000" value="$9000 - $10,000">$9000 - $10,000</option>&#13;
			<option label="$10,000 or more" value="$10,000 or more">$10,000 or more</option>&#13;
			<option label="I’m not sure. Price out the best value for my travel preferences and party size." value="I’m not sure. Price out the best value for my travel preferences and party size.">I’m not sure. Price out the best value for my travel preferences and party size.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="All About You!"/>&#13;
		<field type="text" required="true" label="First" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Street Address" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Address Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="ZIP / Postal Code" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Country" placeholder="Country" name="address-country" className="form-control">&#13;
			<option label="Country" value="">Country</option>&#13;
			<option label="United States" value="United States">United States</option>&#13;
			<option label="Canada" value="Canada">Canada</option>&#13;
			<option label="Afghanistan" value="Afghanistan">Afghanistan</option>&#13;
			<option label="Albania" value="Albania">Albania</option>&#13;
			<option label="Algeria" value="Algeria">Algeria</option>&#13;
			<option label="American Samoa" value="American Samoa">American Samoa</option>&#13;
			<option label="Andorra" value="Andorra">Andorra</option>&#13;
			<option label="Angola" value="Angola">Angola</option>&#13;
			<option label="Antigua and Barbuda" value="Antigua and Barbuda">Antigua and Barbuda</option>&#13;
			<option label="Argentina" value="Argentina">Argentina</option>&#13;
			<option label="Armenia" value="Armenia">Armenia</option>&#13;
			<option label="Australia" value="Australia">Australia</option>&#13;
			<option label="Austria" value="Austria">Austria</option>&#13;
			<option label="Azerbaijan" value="Azerbaijan">Azerbaijan</option>&#13;
			<option label="Bahamas" value="Bahamas">Bahamas</option>&#13;
			<option label="Bahrain" value="Bahrain">Bahrain</option>&#13;
			<option label="Bangladesh" value="Bangladesh">Bangladesh</option>&#13;
			<option label="Barbados" value="Barbados">Barbados</option>&#13;
			<option label="Belarus" value="Belarus">Belarus</option>&#13;
			<option label="Belgium" value="Belgium">Belgium</option>&#13;
			<option label="Belize" value="Belize">Belize</option>&#13;
			<option label="Benin" value="Benin">Benin</option>&#13;
			<option label="Bermuda" value="Bermuda">Bermuda</option>&#13;
			<option label="Bhutan" value="Bhutan">Bhutan</option>&#13;
			<option label="Bolivia" value="Bolivia">Bolivia</option>&#13;
			<option label="Bosnia and Herzegovina" value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>&#13;
			<option label="Botswana" value="Botswana">Botswana</option>&#13;
			<option label="Brazil" value="Brazil">Brazil</option>&#13;
			<option label="Brunei" value="Brunei">Brunei</option>&#13;
			<option label="Bulgaria" value="Bulgaria">Bulgaria</option>&#13;
			<option label="Burkina Faso" value="Burkina Faso">Burkina Faso</option>&#13;
			<option label="Burundi" value="Burundi">Burundi</option>&#13;
			<option label="Cambodia" value="Cambodia">Cambodia</option>&#13;
			<option label="Cameroon" value="Cameroon">Cameroon</option>&#13;
			<option label="Cape Verde" value="Cape Verde">Cape Verde</option>&#13;
			<option label="Central African Republic" value="Central African Republic">Central African Republic</option>&#13;
			<option label="Chad" value="Chad">Chad</option>&#13;
			<option label="Chile" value="Chile">Chile</option>&#13;
			<option label="China" value="China">China</option>&#13;
			<option label="Colombia" value="Colombia">Colombia</option>&#13;
			<option label="Comoros" value="Comoros">Comoros</option>&#13;
			<option label="Congo, Democratic Republic of the" value="Congo, Democratic Republic of the">Congo, Democratic Republic of the</option>&#13;
			<option label="Congo, Republic of the" value="Congo, Republic of the">Congo, Republic of the</option>&#13;
			<option label="Costa Rica" value="Costa Rica">Costa Rica</option>&#13;
			<option label="Côte d'Ivoire" value="Côte d'Ivoire">Côte d'Ivoire</option>&#13;
			<option label="Croatia" value="Croatia">Croatia</option>&#13;
			<option label="Cuba" value="Cuba">Cuba</option>&#13;
			<option label="Cyprus" value="Cyprus">Cyprus</option>&#13;
			<option label="Czech Republic" value="Czech Republic">Czech Republic</option>&#13;
			<option label="Denmark" value="Denmark">Denmark</option>&#13;
			<option label="Djibouti" value="Djibouti">Djibouti</option>&#13;
			<option label="Dominica" value="Dominica">Dominica</option>&#13;
			<option label="Dominican Republic" value="Dominican Republic">Dominican Republic</option>&#13;
			<option label="East Timor" value="East Timor">East Timor</option>&#13;
			<option label="Ecuador" value="Ecuador">Ecuador</option>&#13;
			<option label="Egypt" value="Egypt">Egypt</option>&#13;
			<option label="El Salvador" value="El Salvador">El Salvador</option>&#13;
			<option label="Equatorial Guinea" value="Equatorial Guinea">Equatorial Guinea</option>&#13;
			<option label="Eritrea" value="Eritrea">Eritrea</option>&#13;
			<option label="Estonia" value="Estonia">Estonia</option>&#13;
			<option label="Ethiopia" value="Ethiopia">Ethiopia</option>&#13;
			<option label="Fiji" value="Fiji">Fiji</option>&#13;
			<option label="Finland" value="Finland">Finland</option>&#13;
			<option label="France" value="France">France</option>&#13;
			<option label="Gabon" value="Gabon">Gabon</option>&#13;
			<option label="Gambia" value="Gambia">Gambia</option>&#13;
			<option label="Georgia" value="Georgia">Georgia</option>&#13;
			<option label="Germany" value="Germany">Germany</option>&#13;
			<option label="Ghana" value="Ghana">Ghana</option>&#13;
			<option label="Greece" value="Greece">Greece</option>&#13;
			<option label="Greenland" value="Greenland">Greenland</option>&#13;
			<option label="Grenada" value="Grenada">Grenada</option>&#13;
			<option label="Guam" value="Guam">Guam</option>&#13;
			<option label="Guatemala" value="Guatemala">Guatemala</option>&#13;
			<option label="Guinea" value="Guinea">Guinea</option>&#13;
			<option label="Guinea-Bissau" value="Guinea-Bissau">Guinea-Bissau</option>&#13;
			<option label="Guyana" value="Guyana">Guyana</option>&#13;
			<option label="Haiti" value="Haiti">Haiti</option>&#13;
			<option label="Honduras" value="Honduras">Honduras</option>&#13;
			<option label="Hong Kong" value="Hong Kong">Hong Kong</option>&#13;
			<option label="Hungary" value="Hungary">Hungary</option>&#13;
			<option label="Iceland" value="Iceland">Iceland</option>&#13;
			<option label="India" value="India">India</option>&#13;
			<option label="Indonesia" value="Indonesia">Indonesia</option>&#13;
			<option label="Iran" value="Iran">Iran</option>&#13;
			<option label="Iraq" value="Iraq">Iraq</option>&#13;
			<option label="Ireland" value="Ireland">Ireland</option>&#13;
			<option label="Israel" value="Israel">Israel</option>&#13;
			<option label="Italy" value="Italy">Italy</option>&#13;
			<option label="Jamaica" value="Jamaica">Jamaica</option>&#13;
			<option label="Japan" value="Japan">Japan</option>&#13;
			<option label="Jordan" value="Jordan">Jordan</option>&#13;
			<option label="Kazakhstan" value="Kazakhstan">Kazakhstan</option>&#13;
			<option label="Kenya" value="Kenya">Kenya</option>&#13;
			<option label="Kiribati" value="Kiribati">Kiribati</option>&#13;
			<option label="North Korea" value="North Korea">North Korea</option>&#13;
			<option label="South Korea" value="South Korea">South Korea</option>&#13;
			<option label="Kuwait" value="Kuwait">Kuwait</option>&#13;
			<option label="Kyrgyzstan" value="Kyrgyzstan">Kyrgyzstan</option>&#13;
			<option label="Laos" value="Laos">Laos</option>&#13;
			<option label="Latvia" value="Latvia">Latvia</option>&#13;
			<option label="Lebanon" value="Lebanon">Lebanon</option>&#13;
			<option label="Lesotho" value="Lesotho">Lesotho</option>&#13;
			<option label="Liberia" value="Liberia">Liberia</option>&#13;
			<option label="Libya" value="Libya">Libya</option>&#13;
			<option label="Liechtenstein" value="Liechtenstein">Liechtenstein</option>&#13;
			<option label="Lithuania" value="Lithuania">Lithuania</option>&#13;
			<option label="Luxembourg" value="Luxembourg">Luxembourg</option>&#13;
			<option label="Macedonia" value="Macedonia">Macedonia</option>&#13;
			<option label="Madagascar" value="Madagascar">Madagascar</option>&#13;
			<option label="Malawi" value="Malawi">Malawi</option>&#13;
			<option label="Malaysia" value="Malaysia">Malaysia</option>&#13;
			<option label="Maldives" value="Maldives">Maldives</option>&#13;
			<option label="Mali" value="Mali">Mali</option>&#13;
			<option label="Malta" value="Malta">Malta</option>&#13;
			<option label="Marshall Islands" value="Marshall Islands">Marshall Islands</option>&#13;
			<option label="Mauritania" value="Mauritania">Mauritania</option>&#13;
			<option label="Mauritius" value="Mauritius">Mauritius</option>&#13;
			<option label="Mexico" value="Mexico">Mexico</option>&#13;
			<option label="Micronesia" value="Micronesia">Micronesia</option>&#13;
			<option label="Moldova" value="Moldova">Moldova</option>&#13;
			<option label="Monaco" value="Monaco">Monaco</option>&#13;
			<option label="Mongolia" value="Mongolia">Mongolia</option>&#13;
			<option label="Montenegro" value="Montenegro">Montenegro</option>&#13;
			<option label="Morocco" value="Morocco">Morocco</option>&#13;
			<option label="Mozambique" value="Mozambique">Mozambique</option>&#13;
			<option label="Myanmar" value="Myanmar">Myanmar</option>&#13;
			<option label="Namibia" value="Namibia">Namibia</option>&#13;
			<option label="Nauru" value="Nauru">Nauru</option>&#13;
			<option label="Nepal" value="Nepal">Nepal</option>&#13;
			<option label="Netherlands" value="Netherlands">Netherlands</option>&#13;
			<option label="New Zealand" value="New Zealand">New Zealand</option>&#13;
			<option label="Nicaragua" value="Nicaragua">Nicaragua</option>&#13;
			<option label="Niger" value="Niger">Niger</option>&#13;
			<option label="Nigeria" value="Nigeria">Nigeria</option>&#13;
			<option label="Norway" value="Norway">Norway</option>&#13;
			<option label="Northern Mariana Islands" value="Northern Mariana Islands">Northern Mariana Islands</option>&#13;
			<option label="Oman" value="Oman">Oman</option>&#13;
			<option label="Pakistan" value="Pakistan">Pakistan</option>&#13;
			<option label="Palau" value="Palau">Palau</option>&#13;
			<option label="Palestine" value="Palestine">Palestine</option>&#13;
			<option label="Panama" value="Panama">Panama</option>&#13;
			<option label="Papua New Guinea" value="Papua New Guinea">Papua New Guinea</option>&#13;
			<option label="Paraguay" value="Paraguay">Paraguay</option>&#13;
			<option label="Peru" value="Peru">Peru</option>&#13;
			<option label="Philippines" value="Philippines">Philippines</option>&#13;
			<option label="Poland" value="Poland">Poland</option>&#13;
			<option label="Portugal" value="Portugal">Portugal</option>&#13;
			<option label="Puerto Rico" value="Puerto Rico">Puerto Rico</option>&#13;
			<option label="Qatar" value="Qatar">Qatar</option>&#13;
			<option label="Romania" value="Romania">Romania</option>&#13;
			<option label="Russia" value="Russia">Russia</option>&#13;
			<option label="Rwanda" value="Rwanda">Rwanda</option>&#13;
			<option label="Saint Kitts and Nevis" value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>&#13;
			<option label="Saint Lucia" value="Saint Lucia">Saint Lucia</option>&#13;
			<option label="Saint Vincent and the Grenadines" value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>&#13;
			<option label="Samoa" value="Samoa">Samoa</option>&#13;
			<option label="San Marino" value="San Marino">San Marino</option>&#13;
			<option label="Sao Tome and Principe" value="Sao Tome and Principe">Sao Tome and Principe</option>&#13;
			<option label="Saudi Arabia" value="Saudi Arabia">Saudi Arabia</option>&#13;
			<option label="Senegal" value="Senegal">Senegal</option>&#13;
			<option label="Serbia and Montenegro" value="Serbia and Montenegro">Serbia and Montenegro</option>&#13;
			<option label="Seychelles" value="Seychelles">Seychelles</option>&#13;
			<option label="Sierra Leone" value="Sierra Leone">Sierra Leone</option>&#13;
			<option label="Singapore" value="Singapore">Singapore</option>&#13;
			<option label="Slovakia" value="Slovakia">Slovakia</option>&#13;
			<option label="Slovenia" value="Slovenia">Slovenia</option>&#13;
			<option label="Solomon Islands" value="Solomon Islands">Solomon Islands</option>&#13;
			<option label="Somalia" value="Somalia">Somalia</option>&#13;
			<option label="South Africa" value="South Africa">South Africa</option>&#13;
			<option label="Spain" value="Spain">Spain</option>&#13;
			<option label="Sri Lanka" value="Sri Lanka">Sri Lanka</option>&#13;
			<option label="Sudan" value="Sudan">Sudan</option>&#13;
			<option label="Sudan, South" value="Sudan, South">Sudan, South</option>&#13;
			<option label="Suriname" value="Suriname">Suriname</option>&#13;
			<option label="Swaziland" value="Swaziland">Swaziland</option>&#13;
			<option label="Sweden" value="Sweden">Sweden</option>&#13;
			<option label="Switzerland" value="Switzerland">Switzerland</option>&#13;
			<option label="Syria" value="Syria">Syria</option>&#13;
			<option label="Taiwan" value="Taiwan">Taiwan</option>&#13;
			<option label="Tajikistan" value="Tajikistan">Tajikistan</option>&#13;
			<option label="Tanzania" value="Tanzania">Tanzania</option>&#13;
			<option label="Thailand" value="Thailand">Thailand</option>&#13;
			<option label="Togo" value="Togo">Togo</option>&#13;
			<option label="Tonga" value="Tonga">Tonga</option>&#13;
			<option label="Trinidad and Tobago" value="Trinidad and Tobago">Trinidad and Tobago</option>&#13;
			<option label="Tunisia" value="Tunisia">Tunisia</option>&#13;
			<option label="Turkey" value="Turkey">Turkey</option>&#13;
			<option label="Turkmenistan" value="Turkmenistan">Turkmenistan</option>&#13;
			<option label="Tuvalu" value="Tuvalu">Tuvalu</option>&#13;
			<option label="Uganda" value="Uganda">Uganda</option>&#13;
			<option label="Ukraine" value="Ukraine">Ukraine</option>&#13;
			<option label="United Arab Emirates" value="United Arab Emirates">United Arab Emirates</option>&#13;
			<option label="United Kingdom" value="United Kingdom">United Kingdom</option>&#13;
			<option label="Uruguay" value="Uruguay">Uruguay</option>&#13;
			<option label="Uzbekistan" value="Uzbekistan">Uzbekistan</option>&#13;
			<option label="Vanuatu" value="Vanuatu">Vanuatu</option>&#13;
			<option label="Vatican City" value="Vatican City">Vatican City</option>&#13;
			<option label="Venezuela" value="Venezuela">Venezuela</option>&#13;
			<option label="Vietnam" value="Vietnam">Vietnam</option>&#13;
			<option label="Virgin Islands, British" value="Virgin Islands, British">Virgin Islands, British</option>&#13;
			<option label="Virgin Islands, U.S." value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>&#13;
			<option label="Yemen" value="Yemen">Yemen</option>&#13;
			<option label="Zambia" value="Zambia">Zambia</option>&#13;
			<option label="Zimbabwe" value="Zimbabwe">Zimbabwe</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="State" placeholder="Please Select" name="address-state" className="form-control">&#13;
			<option label="Please Select" value="">Please Select</option>&#13;
			<option label="Alabama" value="Alabama">Alabama</option>&#13;
			<option label="Alaska" value="Alaska">Alaska</option>&#13;
			<option label="Arizona" value="Arizona">Arizona</option>&#13;
			<option label="Arkansas" value="Arkansas">Arkansas</option>&#13;
			<option label="California" value="California">California</option>&#13;
			<option label="Colorado" value="Colorado">Colorado</option>&#13;
			<option label="Connecticut" value="Connecticut">Connecticut</option>&#13;
			<option label="Delaware" value="Delaware">Delaware</option>&#13;
			<option label="District of Columbia" value="District of Columbia">District of Columbia</option>&#13;
			<option label="Florida" value="Florida">Florida</option>&#13;
			<option label="Georgia" value="Georgia">Georgia</option>&#13;
			<option label="Hawaii" value="Hawaii">Hawaii</option>&#13;
			<option label="Idaho" value="Idaho">Idaho</option>&#13;
			<option label="Illinois" value="Illinois">Illinois</option>&#13;
			<option label="Indiana" value="Indiana">Indiana</option>&#13;
			<option label="Iowa" value="Iowa">Iowa</option>&#13;
			<option label="Kansas" value="Kansas">Kansas</option>&#13;
			<option label="Kentucky" value="Kentucky">Kentucky</option>&#13;
			<option label="Louisiana" value="Louisiana">Louisiana</option>&#13;
			<option label="Maine" value="Maine">Maine</option>&#13;
			<option label="Maryland" value="Maryland">Maryland</option>&#13;
			<option label="Massachusetts" value="Massachusetts">Massachusetts</option>&#13;
			<option label="Michigan" value="Michigan">Michigan</option>&#13;
			<option label="Minnesota" value="Minnesota">Minnesota</option>&#13;
			<option label="Mississippi" value="Mississippi">Mississippi</option>&#13;
			<option label="Missouri" value="Missouri">Missouri</option>&#13;
			<option label="Montana" value="Montana">Montana</option>&#13;
			<option label="Nebraska" value="Nebraska">Nebraska</option>&#13;
			<option label="Nevada" value="Nevada">Nevada</option>&#13;
			<option label="New Hampshire" value="New Hampshire">New Hampshire</option>&#13;
			<option label="New Jersey" value="New Jersey">New Jersey</option>&#13;
			<option label="New Mexico" value="New Mexico">New Mexico</option>&#13;
			<option label="New York" value="New York">New York</option>&#13;
			<option label="North Carolina" value="North Carolina">North Carolina</option>&#13;
			<option label="North Dakota" value="North Dakota">North Dakota</option>&#13;
			<option label="Ohio" value="Ohio">Ohio</option>&#13;
			<option label="Oklahoma" value="Oklahoma">Oklahoma</option>&#13;
			<option label="Oregon" value="Oregon">Oregon</option>&#13;
			<option label="Pennsylvania" value="Pennsylvania">Pennsylvania</option>&#13;
			<option label="Rhode Island" value="Rhode Island">Rhode Island</option>&#13;
			<option label="South Carolina" value="South Carolina">South Carolina</option>&#13;
			<option label="South Dakota" value="South Dakota">South Dakota</option>&#13;
			<option label="Tennessee" value="Tennessee">Tennessee</option>&#13;
			<option label="Texas" value="Texas">Texas</option>&#13;
			<option label="Utah" value="Utah">Utah</option>&#13;
			<option label="Vermont" value="Vermont">Vermont</option>&#13;
			<option label="Virginia" value="Virginia">Virginia</option>&#13;
			<option label="Washington" value="Washington">Washington</option>&#13;
			<option label="West Virginia" value="West Virginia">West Virginia</option>&#13;
			<option label="Wisconsin" value="Wisconsin">Wisconsin</option>&#13;
			<option label="Wyoming" value="Wyoming">Wyoming</option>&#13;
			<option label="Armed Forces Americas" value="Armed Forces Americas">Armed Forces Americas</option>&#13;
			<option label="Armed Forces Europe" value="Armed Forces Europe">Armed Forces Europe</option>&#13;
			<option label="Armed Forces Pacific" value="Armed Forces Pacific">Armed Forces Pacific</option>&#13;
		</field>&#13;
		<field type="text" subtype="email" required="true" label="Enter Email" name="email" className="form-control"/>&#13;
		<field type="text" subtype="email" required="true" label="Confirm Email" name="email-confirmation" className="form-control"/>&#13;
		<field type="text" subtype="tel" label="Phone" name="phone-number" className="form-control"/>&#13;
		<field type="select" label="Preferred Contact Method" placeholder="-- Please Select --" name="preferred-contact-method" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Email" value="Email">Email</option>&#13;
			<option label="Phone" value="Phone">Phone</option>&#13;
			<option label="No Preference" value="No Preference">No Preference</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Your Travel Party"/>&#13;
		<field type="select" label="Will anyone in your travel party require handicap accessible accommodations?" placeholder="-- Please Select --" name="handicap-accessible-required" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="No" value="No">No</option>&#13;
			<option label="Yes, my needs are listed below" value="Yes, my needs are listed below">Yes, my needs are listed below</option>&#13;
		</field>&#13;
		<field type="textarea" label="Please list your  handicap accessible requirements:" name="handicap-accessible-requirements" rows="10" className="form-control"/>&#13;
		<field type="select" required="true" label="How many people will be traveling?" placeholder="-- Please Select --" name="number-of-travelers" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
			<option label="8" value="8">8</option>&#13;
			<option label="9" value="9">9</option>&#13;
			<option label="10" value="10">10</option>&#13;
			<option label="11" value="11">11</option>&#13;
			<option label="12" value="12">12</option>&#13;
			<option label="13" value="13">13</option>&#13;
			<option label="14" value="14">14</option>&#13;
			<option label="15" value="15">15</option>&#13;
			<option label="16" value="16">16</option>&#13;
			<option label="17" value="17">17</option>&#13;
			<option label="18" value="18">18</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Please list all people in your travel party" name="travel-party-list" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Your Walt Disney World Resort"/>&#13;
		<field type="select" required="true" label="Do you want a Walt Disney World Vacation Package with room and tickets or Room Only?" placeholder="-- Please Select --" name="wdw-package-type" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Walt Disney World Vacation Package (Room and tickets)" value="Walt Disney World Vacation Package (Room and tickets)">Walt Disney World Vacation Package (Room and tickets)</option>&#13;
			<option label="Room-Only Reservation (No tickets)" value="Room-Only Reservation (No tickets)">Room-Only Reservation (No tickets)</option>&#13;
		</field>&#13;
		<field type="radio-group" label="At which Resort would you like to stay" description="After you select a resort category  your resort choices will auto populate below." name="resort-category" className="radio-group">&#13;
			<option label="Disney Value Resort" value="1287">Disney Value Resort</option>&#13;
			<option label="Disney Moderate Resort" value="1288">Disney Moderate Resort</option>&#13;
			<option label="Disney Deluxe Resort" value="1289">Disney Deluxe Resort</option>&#13;
			<option label="Disney Deluxe Villa Resort" value="1290">Disney Deluxe Villa Resort</option>&#13;
			<option label="Other Non-Disney Resorts" value="1291">Other Non-Disney Resorts</option>&#13;
		</field>&#13;
		<field type="select" label="Please select your preferred Resort." description="Please select a resort type first  this section will auto-populate with resorts." placeholder="Please select a resort" name="preferred-resort" className="form-control">&#13;
			<option label="Option 1" value="option-1">Option 1</option>&#13;
			<option label="Option 2" value="option-2">Option 2</option>&#13;
			<option label="Option 3" value="option-3">Option 3</option>&#13;
		</field>&#13;
		<field type="select" label="Choose your Walt Disney World Resort Room Type" placeholder="-- Please Select --" name="wdw-resort-room-type" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Standard" value="Standard">Standard</option>&#13;
			<option label="Preferred" value="Preferred">Preferred</option>&#13;
			<option label="Club Level Standard at a Deluxe Resort" value="Club Level Standard at a Deluxe Resort">Club Level Standard at a Deluxe Resort</option>&#13;
			<option label="Club Level Preferred at a Deluxe Resort" value="Club Level Preferred at a Deluxe Resort">Club Level Preferred at a Deluxe Resort</option>&#13;
			<option label="Family Suite at a Disney Value Resort" value="Family Suite at a Disney Value Resort">Family Suite at a Disney Value Resort</option>&#13;
			<option label="Villa" value="Villa">Villa</option>&#13;
			<option label="Cabin" value="Cabin">Cabin</option>&#13;
			<option label="Not sure - please price out the room type that best fits my party size and budget" value="Not sure - please price out the room type that best fits my party size and budget">Not sure - please price out the room type that best fits my party size and budget</option>&#13;
		</field>&#13;
		<field type="textarea" label="Do you want a specific room theme, bed configuration, location or view? Please list your preferences below:" name="room-preferences" rows="10" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Disney Theme Park Tickets"/>&#13;
		<field type="select" required="true" label="Do you want to add Walt Disney World theme park tickets to your reservation?" placeholder="-- Please Select --" name="wdw-theme-park-tickets" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="No Tickets" value="No Tickets">No Tickets</option>&#13;
			<option label="Two Days" value="Two Days">Two Days</option>&#13;
			<option label="Three Days" value="Three Days">Three Days</option>&#13;
			<option label="Four Days" value="Four Days">Four Days</option>&#13;
			<option label="Five Days" value="Five Days">Five Days</option>&#13;
			<option label="Six Days" value="Six Days">Six Days</option>&#13;
			<option label="Seven Days" value="Seven Days">Seven Days</option>&#13;
			<option label="Eight Days" value="Eight Days">Eight Days</option>&#13;
			<option label="Nine Days" value="Nine Days">Nine Days</option>&#13;
			<option label="Ten Days" value="Ten Days">Ten Days</option>&#13;
			<option label="Annual Pass" value="Annual Pass">Annual Pass</option>&#13;
			<option label="I’m not sure" value="I’m not sure">I’m not sure</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What type of Walt Disney World theme park ticket do you want?" placeholder="-- Please Select --" name="wdw-ticket-type" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Base Ticket - Includes admission to one park per day" value="Base Ticket - Includes admission to one park per day">Base Ticket - Includes admission to one park per day</option>&#13;
			<option label="Park Hopper - Includes same-day admission to all 4 theme parks" value="Park Hopper - Includes same-day admission to all 4 theme parks">Park Hopper - Includes same-day admission to all 4 theme parks</option>&#13;
			<option label="Water Park and Sports Option - Includes admission to one park per day plus visits to a water park or other fun" value="Water Park and Sports Option - Includes admission to one park per day plus visits to a water park or other fun">Water Park and Sports Option - Includes admission to one park per day plus visits to a water park or other fun</option>&#13;
			<option label="Park Hopper Plus Option - Includes same-day admission to all 4 theme parks plus visits to a water park or other fun" value="Park Hopper Plus Option - Includes same-day admission to all 4 theme parks plus visits to a water park or other fun">Park Hopper Plus Option - Includes same-day admission to all 4 theme parks plus visits to a water park or other fun</option>&#13;
			<option label="I’m not sure" value="I’m not sure">I’m not sure</option>&#13;
			<option label="No Ticket" value="No Ticket">No Ticket</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Optional Vacation Add-Ons"/>&#13;
		<field type="select" label="Disney Dining Plan" description="Do you want to add a Dining Plan to your Walt Disney World Vacation?" placeholder="-- Please Select --" name="disney-dining-plan" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Quick Service Plan (Counter Service Locations)" value="Quick Service Plan (Counter Service Locations)">Quick Service Plan (Counter Service Locations)</option>&#13;
			<option label="Table Service Dining Plan" value="Table Service Dining Plan">Table Service Dining Plan</option>&#13;
			<option label="No Dining Plan" value="No Dining Plan">No Dining Plan</option>&#13;
			<option label="I’m not sure" value="I’m not sure">I’m not sure</option>&#13;
		</field>&#13;
		<field type="select" label="Disney VIP Tour" description="Add an Official Disney VIP Tour?" placeholder="-- Please Select --" name="disney-vip-tour" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Yes, I want a Disney VIP Tour" value="Yes, I want a Disney VIP Tour">Yes, I want a Disney VIP Tour</option>&#13;
			<option label="No VIP Tour" value="No VIP Tour">No VIP Tour</option>&#13;
			<option label="I’m not sure" value="I’m not sure">I’m not sure</option>&#13;
		</field>&#13;
		<field type="select" label="Memory Maker" description="Add Memory Maker Digital Photo Package?" placeholder="-- Please Select --" name="memory-maker" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Yes, add Memory Maker Digital Photo Package" value="Yes, add Memory Maker Digital Photo Package">Yes, add Memory Maker Digital Photo Package</option>&#13;
			<option label="No Memory Maker" value="No Memory Maker">No Memory Maker</option>&#13;
			<option label="I’m not sure" value="I’m not sure">I’m not sure</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Pre/Post Stay Add-ons"/>&#13;
		<field type="select" label="Add a pre/post stay at an on-site Universal Orlando Resort Hotel?" placeholder="-- Please Select --" name="pre-post-stay-universal" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Yes, I’m interested in adding pre or post Universal Orlando Resort." value="Yes, I’m interested in adding pre or post Universal Orlando Resort.">Yes, I’m interested in adding pre or post Universal Orlando Resort.</option>&#13;
			<option label="No Universal Orlando" value="No Universal Orlando">No Universal Orlando</option>&#13;
			<option label="I’m not sure" value="I’m not sure">I’m not sure</option>&#13;
		</field>&#13;
		<field type="select" label="Add a Disney Cruise before or after your Walt Disney World Vacation?" placeholder="-- Please Select --" name="pre-post-disney-cruise" className="form-control">&#13;
			<option label="-- Please Select --" value="">-- Please Select --</option>&#13;
			<option label="Yes, I’m interested in adding a Disney Cruise." value="Yes, I’m interested in adding a Disney Cruise.">Yes, I’m interested in adding a Disney Cruise.</option>&#13;
			<option label="No Disney Cruise" value="No Disney Cruise">No Disney Cruise</option>&#13;
			<option label="I’m not sure" value="I’m not sure">I’m not sure</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Please add my email address to Lets Go Travel Agency mailing list:" description="We promise NEVER to sell your email address to a third party. Privacy Policy" inline="true" name="mailing-list" className="radio-group">&#13;
			<option label="Yes" value="Yes">Yes</option>&#13;
			<option label="No" value="No">No</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>