Share your information with Kelsey Oliveira

Kelsey Oliveira

Breakthrough Travel Co.

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	<fields>&#13;
		<field type="header" subtype="h2" label="Let&#39;s plan your trip!"/>&#13;
		<field type="paragraph" subtype="p" label="My goal is to learn about you, your family, and your goals for your trip so I can make the perfect recommendations and help you plan the perfect vacation! As your certified travel planner, I am here to help you plan and book your trips, tickets, hotels, tours, and more. When you book through me, my services are free! Travel providers pay me to make your life easier! The best thing is that your trip will cost the same either way. So, let&#39;s get you booked!"/>&#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="checkbox-group" required="true" label="How would you like to communicate?" name="how-would-you-like-to-communicate">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Text message" value="text-message">Text message</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Where would you like to go?" name="where-would-you-like-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="Royal Caribbean Cruise" value="royal-caribbean-cruise">Royal Caribbean Cruise</option>&#13;
			<option label="Universal Orlando Resort" value="universal-orlando-resort">Universal Orlando Resort</option>&#13;
			<option label="Universal Studios Hollywood" value="universal-studios-hollywood">Universal Studios Hollywood</option>&#13;
			<option label="Aulani" value="aulani">Aulani</option>&#13;
			<option label="Adventures by Disney" value="adventures-by-disney">Adventures by Disney</option>&#13;
			<option label="All Inclusive Resort" value="all-inclusive-resort">All Inclusive Resort</option>&#13;
			<option label="Other Cruise Line" value="other-cruise-line">Other Cruise Line</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="date" required="true" label="When would you like to depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Are your dates flexible?" name="dates-flexible">&#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="How many adults (18 and over) are in your party?&amp;nbsp;" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What are the adult&#39;s names?" name="text-1762133304022" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many children (0-17 years) are in your party?" name="text-1762133279424" subtype="text" className="form-control"/>&#13;
		<field type="text" label="If you have children in your party, please list all of their names and their ages (at time of travel) below." name="text-1762134416293" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Let&#39;s talk budget. This is just a guess on what you want to spend. I will work with you to make sure we plan the trip you want around your ideal budget. Once we start working together, having this info gives us a good starting point.&amp;nbsp;" description="If you&#39;re thinking Disney or Universal  your budget should include your  resort + park tickets." name="budget">&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" label="If you are planning Disney- when you think of a resort at Disney which of these fits your plans best?*" name="hotel-preference" other="true">&#13;
			<option label="Larger than life Disney fun at an affordable price" value="larger-than-life-disney-fun-at-an-affordable-price">Larger than life Disney fun at an affordable price</option>&#13;
			<option label="Classic theming from around the world with a balance of cost vs amenities" value="classic-theming-from-around-the-world-with-a-balance-of-cost-vs-amenities">Classic theming from around the world with a balance of cost vs amenities</option>&#13;
			<option label="Luxury Disney style" value="luxury-disney-style">Luxury Disney style</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="If you are planning a cruise, what type of stateroom are you interested in?" name="if-you-are-planning-a-cruise-what-type-of-stateroom-are-you-interested-in">&#13;
			<option label="Inside" value="inside">Inside</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Verandah/ Balcony" value="verandah-balcony">Verandah/ Balcony</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="There are special discounts for certain groups. Are you any of the following? Choose all that apply:" name="there-are-special-discounts-for-certain-groups-are-you-any-of-the-following-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="Florida Resident (Walt Disney World)" value="florida-resident-walt-disney-world">Florida Resident (Walt Disney World)</option>&#13;
			<option label="Annual Passholder (WDW)" value="annual-passholder-wdw">Annual Passholder (WDW)</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;
			<option label="None" value="none">None</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know? Are you celebrating anything special?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
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