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Rhine Highlights River Cruise

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	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-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="date" required="true" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="radio-group" 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;
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		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" 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" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Emergency Contact Information"/>&#13;
		<field type="text" required="true" label="Name" name="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" label="Relationship to you" name="emergency-contact-relationship" 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="text" required="true" label="Allergies" name="allergies" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Type of Cabin" name="type-of-cabin" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Roommate" name="roommate" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Terms and Agreement: I have read and accept the terms and agreement listed" name="terms-and-agreement-i-have-read-and-accept-the-terms-and-agreement-listed">&#13;
			<option label="Agree" value="agree">Agree</option>&#13;
		</field>&#13;
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</html>

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-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="date" required="true" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="radio-group" 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="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" 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" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Emergency Contact Information"/>&#13;
		<field type="text" required="true" label="Name" name="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" label="Relationship to you" name="emergency-contact-relationship" 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="text" required="true" label="Allergies" name="allergies" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Type of Cabin" name="type-of-cabin" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Roommate" name="roommate" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Terms and Agreement: I have read and accept the terms and agreement listed" name="terms-and-agreement-i-have-read-and-accept-the-terms-and-agreement-listed">&#13;
			<option label="Agree" value="agree">Agree</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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Rhine Highlights River Cruise

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Rhine Highlights River Cruise

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Rhine Highlights River Cruise

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Credit Card Authorization

Authorize deposit

Final payment of $7,195.00 is due on February 26, 2026

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Authorize full amount

$7,195.00

Rhine Highlights River Cruise

Rhine Highlights River Cruise

Rhine Highlights River Cruise

Rhine Highlights River Cruise

Select travelers

Select your package

Add extra options

Enter traveler information

Primary Traveler

INCOMPLETE

Credit Card Authorization

Authorize deposit Final payment of $7,195.00 is due on February 26, 2026

$0.00

Authorize full amount

$7,195.00

Rhine Highlights River Cruise

Rhine Highlights River Cruise

Rhine Highlights River Cruise

Authorize deposit

Final payment of $7,195.00 is due on February 26, 2026