Share your information with Rachel Blum

Rachel Blum

Travelmation

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		<field type="paragraph" subtype="p" label="Thank you SO much for reaching out about planning your Walt Disney World vacation! I look forward to working with you to create lasting memories for you and your family! Please fill out the questions below to help me get started with your trip. ***I do ask that if we work together, you book DIRECTLY with me and not on your own or through another travel agent. My services are 100% free and does NOT cost you any extra on your total price. I am SO excited to plan with you and thank you again for choosing to support my small business!&amp;nbsp;"/>&#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="textarea" required="true" label="All traveler information&amp;nbsp;" placeholder="Please provide full names &amp;amp; birthdates for all travelers" name="all-traveler-information-" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Disney Info"/>&#13;
		<field type="date" required="true" label="Departure Date" name="departure-date" className="form-control"/>&#13;
		<field type="date" required="true" label="Return Date" name="return-date" className="form-control"/>&#13;
		<field type="radio-group" label="Will this be your first trip to Walt Disney World?" name="will-this-be-your-first-trip-to-walt-disney-world">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="I've been but it's someone in my parties first time" value="ive-been-but-its-someone-in-my-parties-first-time">I've been but it's someone in my parties first time</option>&#13;
		</field>&#13;
		<field type="select" label="How soon are you looking to book?" name="how-soon-are-you-looking-to-book" className="form-control">&#13;
			<option label="ASAP" value="asap">ASAP</option>&#13;
			<option label="Within 7-10 days " value="within-710-days-">Within 7-10 days </option>&#13;
			<option label="Within the month" value="within-the-month">Within the month</option>&#13;
			<option label="Considering Options" value="considering-options">Considering Options</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Hotel Category Preference" name="what-is-your-total-budget-for-all-travelers">&#13;
			<option label="Value (~$175-$250 per night)" value="value-175250-per-night">Value (~$175-$250 per night)</option>&#13;
			<option label="Moderate ($250+ per night)" value="moderate-250-per-night">Moderate ($250+ per night)</option>&#13;
			<option label="Deluxe ($400+ per night)" value="deluxe-400-per-night">Deluxe ($400+ per night)</option>&#13;
			<option label="Off property" value="off-property">Off property</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What is the preferred ticket option?" name="what-is-the-preferred-ticket-option" className="form-control">&#13;
			<option label="Base ticket (one park per day)" value="base-ticket-one-park-per-day">Base ticket (one park per day)</option>&#13;
			<option label="Park Hopper (multiple parks per day)" value="park-hopper-multiple-parks-per-day">Park Hopper (multiple parks per day)</option>&#13;
			<option label="Park Hopper Plus (multiple parks per day PLUS waterparks)" value="park-hopper-plus-multiple-parks-per-day-plus-waterparks">Park Hopper Plus (multiple parks per day PLUS waterparks)</option>&#13;
			<option label="I would like more information" value="i-would-like-more-information">I would like more information</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many days would you like to visit the parks?" placeholder="ex: 3 park days" name="how-many-days-would-you-like-to-visit-the-parks" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What type of dining plan are you interested in?" name="what-type-of-dining-plan-are-you-interested-in">&#13;
			<option label="Quick Service" value="quick-service">Quick Service</option>&#13;
			<option label="Disney Dining plan" value="disney-dining-plan">Disney Dining plan</option>&#13;
			<option label="I want more info about the dining plan" value="i-want-more-info-about-the-dining-plan">I want more info about the dining plan</option>&#13;
			<option label="I do not want the dining plan" value="i-do-not-want-the-dining-plan">I do not want the dining plan</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What parks would you like to visit? (Check all that apply)" name="what-parks-would-you-like-to-visit">&#13;
			<option label="Magic Kingdom" value="magic-kingdom">Magic Kingdom</option>&#13;
			<option label="Animal Kingdom" value="animal-kingdom">Animal Kingdom</option>&#13;
			<option label="Epcot" value="epcot">Epcot</option>&#13;
			<option label="Hollywood Studios" value="hollywood-studios">Hollywood Studios</option>&#13;
			<option label="Typhoon Lagoon/Blizzard Beach (waterparks)" value="typhoon-lagoonblizzard-beach-waterparks">Typhoon Lagoon/Blizzard Beach (waterparks)</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Will you be celebrating anything will visiting Walt Disney World?" name="will-you-be-celebrating-anything-will-visiting-walt-disney-world">&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="First Visit" value="first-visit">First Visit</option>&#13;
			<option label="Graduation" value="graduation">Graduation</option>&#13;
			<option label="Engagement" value="engagement">Engagement</option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Just Celebrating" value="just-celebrating">Just Celebrating</option>&#13;
			<option label="Holidays" value="holidays">Holidays</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know?" name="what-else-would-you-like-me-to-know" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Thank you so much for taking the time to complete this form! If you need more information about Disney, please let me know and I can provide as much as necessary to plan the best trip! --Rachel"/>&#13;
	</fields>&#13;
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