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Essence of Burgundy & Provence

Apr 8, 2027 to Apr 15, 2027

Provence & Burgundy Regions of France

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		<field type="header" subtype="h2" label="Contact Information"/>&#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" 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" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="clientLoyaltyPrograms" label="Loyalty Programs" 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="header" subtype="h2" label="Passport Information&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Full name as it appears on passport&amp;nbsp;" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Document Number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country of issue or State (USA Only)" 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="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of expiration" name="passport-date-of-expiration" 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;
			<option label="X" value="other">X</option>&#13;
		</field>&#13;
		<field type="date" label="Anniversary Date&amp;nbsp;" name="anniversary-date-" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Emergency Contact Information"/>&#13;
		<field type="text" required="true" label="Full name" name="emergency-contact-full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="emergency-contact-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Relationship to you" name="emergency-contact-relationship" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Special Needs- Food restrictions, CPAP, etc." name="special-needs-food-restrictions-cpap-etc" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Protection"/>&#13;
		<field type="text" required="true" label="Disclaimer" name="disclaimer" value="By signing this document  I understand that declining travel insurance could result in the loss of my travel cost and/or require more money to correct the situation. I also acknowledge that without insurance  there may be no way to recoup any losses  costs or expenses incurred." subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Travel Protection" inline="true" name="travel-protection">&#13;
			<option label="I ACCEPT Travel Insurance" value="i-accept-travel-insurance">I ACCEPT Travel Insurance</option>&#13;
			<option label="I DECLINE Travel Insurance, I understand that this could result in the loss of ALL of my travel costs." value="i-decline-travel-insurance-i-understand-that-this-could-result-in-the-loss-of-all-of-my-travel-costs">I DECLINE Travel Insurance, I understand that this could result in the loss of ALL of my travel costs.</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

By signing below, I authorize Travel Designs to charge the credit card provided herein.

Click to sign

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#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" required="true" label="Preferred name (nickname)" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" 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" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="clientLoyaltyPrograms" label="Loyalty Programs" 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="header" subtype="h2" label="Passport Information&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Full name as it appears on passport&amp;nbsp;" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Document Number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country of issue or State (USA Only)" 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="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of expiration" name="passport-date-of-expiration" 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;
			<option label="X" value="other">X</option>&#13;
		</field>&#13;
		<field type="date" label="Anniversary Date&amp;nbsp;" name="anniversary-date-" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Emergency Contact Information"/>&#13;
		<field type="text" required="true" label="Full name" name="emergency-contact-full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="emergency-contact-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Relationship to you" name="emergency-contact-relationship" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Special Needs- Food restrictions, CPAP, etc." name="special-needs-food-restrictions-cpap-etc" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Protection"/>&#13;
		<field type="text" required="true" label="Disclaimer" name="disclaimer" value="By signing this document  I understand that declining travel insurance could result in the loss of my travel cost and/or require more money to correct the situation. I also acknowledge that without insurance  there may be no way to recoup any losses  costs or expenses incurred." subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Travel Protection" inline="true" name="travel-protection">&#13;
			<option label="I ACCEPT Travel Insurance" value="i-accept-travel-insurance">I ACCEPT Travel Insurance</option>&#13;
			<option label="I DECLINE Travel Insurance, I understand that this could result in the loss of ALL of my travel costs." value="i-decline-travel-insurance-i-understand-that-this-could-result-in-the-loss-of-all-of-my-travel-costs">I DECLINE Travel Insurance, I understand that this could result in the loss of ALL of my travel costs.</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

Continue to traveler info

Credit Card Authorization

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Final payment of $5,559.00 is due on January 5, 2027

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By signing below, I authorize Travel Designs to charge the credit card provided herein.

Click to sign

Essence of Burgundy & Provence

Apr 8, 2027 to Apr 15, 2027

Provence & Burgundy Regions of France

Category E- Piano Deck —

—

Total —

Due now —

Continue to traveler info

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Essence of Burgundy & Provence

Apr 8, 2027 to Apr 15, 2027

Provence & Burgundy Regions of France

Category E- Piano Deck —

—

Total —

Due now —

Continue to traveler info

Essence of Burgundy & Provence

Apr 8, 2027 to Apr 15, 2027

Provence & Burgundy Regions of France

Select travelers

Select your package

Enter traveler information

Primary Traveler

INCOMPLETE

Credit Card Authorization

Authorize deposit

Final payment of $5,559.00 is due on January 5, 2027

$0.00

Authorize full amount

$5,559.00

Essence of Burgundy & Provence

Essence of Burgundy & Provence

Apr 8, 2027 to Apr 15, 2027

Provence & Burgundy Regions of France

Essence of Burgundy & Provence

Apr 8, 2027 to Apr 15, 2027

Provence & Burgundy Regions of France

Essence of Burgundy & Provence

Apr 8, 2027 to Apr 15, 2027

Provence & Burgundy Regions of France

Select travelers

Select your package

Enter traveler information

Primary Traveler

INCOMPLETE

Credit Card Authorization

Authorize deposit Final payment of $5,559.00 is due on January 5, 2027

$0.00

Authorize full amount

$5,559.00

Essence of Burgundy & Provence

Essence of Burgundy & Provence

Apr 8, 2027 to Apr 15, 2027

Provence & Burgundy Regions of France

Essence of Burgundy & Provence

Apr 8, 2027 to Apr 15, 2027

Provence & Burgundy Regions of France

Authorize deposit

Final payment of $5,559.00 is due on January 5, 2027