Share your information with Nicole Delaney

Nicole Delaney

Luxe & Away

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h3" label="Personal 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" 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="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How Many Travelers?" name="text-1767997786017" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Names and DOB of Travelers&amp;nbsp;" name="text-1767997800017" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Trip Questions&amp;nbsp;"/>&#13;
		<field type="checkbox-group" required="true" label="Year of Travel&amp;nbsp;" name="checkbox-group-1767997896289">&#13;
			<option label="2026" value="2026">2026</option>&#13;
			<option label="2027" value="2027">2027</option>&#13;
		</field>&#13;
		<field type="date" required="true" label="When would you &amp;nbsp;like to depart?" description="This gives me a general idea of when you are thinking of traveling" name="date-1767997937476" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?&amp;nbsp;" description="This gives me a general idea of when you would like to return. It can be changed later" name="date-1767998033241" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Are your dates flexible?" name="checkbox-group-1767998072787">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What kind of services are you looking for&amp;nbsp;" name="select-1767998123743" className="form-control">&#13;
			<option label="Booking Only (resort,  park tickets, cruise) " value="booking-only-resort-park-tickets-cruise-">Booking Only (resort,  park tickets, cruise) </option>&#13;
			<option label="Full Service (resort, park tickets, ride reservations, restaurant reservations, etc)" value="full-service-resort-park-tickets-ride-reservations-restaurant-reservations-etc">Full Service (resort, park tickets, ride reservations, restaurant reservations, etc)</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What Disney destination are you looking for?&amp;nbsp;" name="select-1767998235746" className="form-control">&#13;
			<option label="Walt Disney World (Orlando, FL)" value="walt-disney-world-orlando-fl">Walt Disney World (Orlando, FL)</option>&#13;
			<option label="Disneyland (Anaheim, CA)" value="disneyland-anaheim-ca">Disneyland (Anaheim, CA)</option>&#13;
			<option label="Disney Cruise Line " value="disney-cruise-line-">Disney Cruise Line </option>&#13;
			<option label="Aulani Disney Resort &amp; Spa (Hawaii)" value="aulani-disney-resort-spa-hawaii">Aulani Disney Resort &amp; Spa (Hawaii)</option>&#13;
			<option label="Land &amp; Sea (Park &amp; Cruise) " value="land-sea-park-cruise-">Land &amp; Sea (Park &amp; Cruise) </option>&#13;
			<option label="Adventures By Disney " value="adventures-by-disney-">Adventures By Disney </option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is your departure city?" name="text-1767998351283" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers (not including airfare)" name="radio-group-1767998397789">&#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 $8,000" value="5000-to-8000">$5,000 to $8,000</option>&#13;
			<option label="$8,000 to $10,000" value="8000-to-10000">$8,000 to $10,000</option>&#13;
			<option label="We want to do ALL the things, no budget limits!" value="we-want-to-do-all-the-things-no-budget-limits">We want to do ALL the things, no budget limits!</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Resort Type" name="radio-group-1767998506715">&#13;
			<option label="Value Resorts (from $175+/nt.)" value="value-resorts-from-175nt">Value Resorts (from $175+/nt.)</option>&#13;
			<option label="Moderate Resorts (from $275+/nt.)" value="moderate-resorts-from-275nt">Moderate Resorts (from $275+/nt.)</option>&#13;
			<option label="Deluxe Resort (from $450+/nt.)" value="deluxe-resort-from-450nt">Deluxe Resort (from $450+/nt.)</option>&#13;
			<option label="Villas/Suites (from $600+/nt.)" value="villassuites-from-600nt">Villas/Suites (from $600+/nt.)</option>&#13;
			<option label="Multi Room Villa/Suite (from $900+/nt.)" value="multi-room-villasuite-from-900nt">Multi Room Villa/Suite (from $900+/nt.)</option>&#13;
			<option label="Other " value="other-">Other </option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Do you have a specific resort in mind?" name="text-1767998674509" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What type of park ticket are you interested in?" name="checkbox-group-1767998702607">&#13;
			<option label="Base Ticket (1 park per day, no park hopping)" value="base-ticket-1-park-per-day-no-park-hopping">Base Ticket (1 park per day, no park hopping)</option>&#13;
			<option label="Park Hopper (any park, any time)" value="park-hopper-any-park-any-time">Park Hopper (any park, any time)</option>&#13;
			<option label="Park Hopper w/Water Park (includes water park admission)" value="park-hopper-wwater-park-includes-water-park-admission">Park Hopper w/Water Park (includes water park admission)</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="How many days would you like to spend in the park?" name="select-1767998787882" className="form-control">&#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="Does not apply " value="does-not-apply-">Does not apply </option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Would you like to include a Disney Dining Plan?" name="select-1767998856386" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Does not apply to my trip " value="does-not-apply-to-my-trip-">Does not apply to my trip </option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Are you interest in extras? (Check all that apply)&amp;nbsp;" name="checkbox-group-1767998942633">&#13;
			<option label="Character Meals" value="character-meals">Character Meals</option>&#13;
			<option label="Table Service Restaurants " value="table-service-restaurants-">Table Service Restaurants </option>&#13;
			<option label="Lightning Lanes " value="lightning-lanes-">Lightning Lanes </option>&#13;
			<option label="Private Transfer (to and from airport) " value="private-transfer-to-and-from-airport-">Private Transfer (to and from airport) </option>&#13;
			<option label="Disney Memory Maker (photos) " value="disney-memory-maker-photos-">Disney Memory Maker (photos) </option>&#13;
			<option label="Cabana Rentals (cruise only)" value="cabana-rentals-cruise-only">Cabana Rentals (cruise only)</option>&#13;
			<option label="Shore Excursions (cruise only)" value="shore-excursions-cruise-only">Shore Excursions (cruise only)</option>&#13;
			<option label="I'm not sure " value="im-not-sure-">I'm not sure </option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Are you celebrating something special?" name="select-1767999077353" className="form-control">&#13;
			<option label="1st Visit" value="1st-visit">1st Visit</option>&#13;
			<option label="Birthday " value="birthday-">Birthday </option>&#13;
			<option label="Anniversary " value="anniversary-">Anniversary </option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Does not apply to me " value="does-not-apply-to-me-">Does not apply to me </option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Is this your first visit or sailing?&amp;nbsp;" name="select-1767999131462" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Does anyone in party require special accommodations?&amp;nbsp;" name="text-1767999172114" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Anything else you would like me to know?" name="text-1767999213572" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Is there anyone we can thank for reffering us?" name="text-1768083031660" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Would you like to be added to our newsletter?" name="checkbox-group-1768083053418">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>