Share your information with Sandra Dee Danielson

Sandra Dee Danielson

Travelmation LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First Name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Middle name" name="middle-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="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Preferred Name (nickname)" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Primary Email Address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Primary 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" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Full name as it appears on passport or birth certificate" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of Birth" name="birthday" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Dates"/>&#13;
		<field type="date" required="true" label="Date You&#39;d Like To Depart" name="date-youd-like-to-depart" className="form-control"/>&#13;
		<field type="date" required="true" label="Date You&#39;d Like To Return" name="date-youd-like-to-return" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Budget"/>&#13;
		<field type="text" required="true" label="What Is Your Budget? I want to keep you within your budget but I must know what we are aiming for." name="what-is-your-budget-i-want-to-keep-you-within-your-budget-but-i-must-know-what-we-are-aiming-for" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Disney Destination"/>&#13;
		<field type="radio-group" required="true" label="Which Disney Destination Do You Want To Visit" name="which-disney-destination-do-you-want-to-visit">&#13;
			<option label="Walt Disney World Resort (Orlando, Florida, USA)" value="walt-disney-world-resort-orlando-florida-usa">Walt Disney World Resort (Orlando, Florida, USA)</option>&#13;
			<option label="Disneyland Resort (Anaheim, California, USA)" value="disneyland-resort-anaheim-california-usa">Disneyland Resort (Anaheim, California, USA)</option>&#13;
			<option label="Tokyo Disney Resort (Urayasu, Chiba Prefecture, Japan)" value="tokyo-disney-resort-urayasu-chiba-prefecture-japan">Tokyo Disney Resort (Urayasu, Chiba Prefecture, Japan)</option>&#13;
			<option label="Disneyland Paris (Marne-la-Vallée, France)" value="disneyland-paris-marnelavalle-france">Disneyland Paris (Marne-la-Vallée, France)</option>&#13;
			<option label="Hong Kong Disneyland Resort (Lantau Island, Hong Kong)" value="hong-kong-disneyland-resort-lantau-island-hong-kong">Hong Kong Disneyland Resort (Lantau Island, Hong Kong)</option>&#13;
			<option label="Shanghai Disney Resort (Chuansha New Town, Pudong, Shanghai, China)" value="shanghai-disney-resort-chuansha-new-town-pudong-shanghai-china">Shanghai Disney Resort (Chuansha New Town, Pudong, Shanghai, China)</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Tickets"/>&#13;
		<field type="text" required="true" label="Number of Days You&#39;d Like Tickets For" name="number-of-days-youd-like-tickets-for" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Type of Tickets" name="type-of-tickets">&#13;
			<option label="1 Park Per Day - Visit 1 theme park each day of your ticket." value="1-park-per-day-visit-1-theme-park-each-day-of-your-ticket">1 Park Per Day - Visit 1 theme park each day of your ticket.</option>&#13;
			<option label="Park Hopper - Visit multiple theme parks each day of your ticket." value="park-hopper-visit-multiple-theme-parks-each-day-of-your-ticket">Park Hopper - Visit multiple theme parks each day of your ticket.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Resort Information"/>&#13;
		<field type="radio-group" required="true" label="Type of Resort You Are Interested In" name="which-cruise-line-are-you-interested-in">&#13;
			<option label="Deluxe Resorts" value="deluxe-resorts">Deluxe Resorts</option>&#13;
			<option label="Moderate Resorts" value="moderate-resorts">Moderate Resorts</option>&#13;
			<option label="Value Resorts" value="value-resorts">Value Resorts</option>&#13;
		</field>&#13;
		<field type="text" label="If you know the resort you&#39;d like to stay at, enter it here." name="if-you-know-the-resort-youd-like-to-stay-at-enter-it-here" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of Adults and Children Traveling" name="number-of-adults-and-children-traveling" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Ages of Children at Time of Travel (Very Important)" name="ages-of-children-at-time-of-travel-very-important" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is the Room Configuration (# of rooms &amp;amp; how many adults and children in each room)" name="what-is-the-room-configuration-of-rooms-how-many-adults-and-children-in-each-room" subtype="text" className="form-control"/>&#13;
		<field type="clientLoyaltyPrograms" label="Loyalty Programs (Specific for this trip)" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/>&#13;
		<field type="text" label="Do you have accessibility needs?" name="do-you-have-accessibility-needs" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Additional Information - Is there anything additional you&#39;d like for me to know?" name="additional-information" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>