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<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Primary Traveler Information"/>&#13;
		<field type="radio-group" required="true" label="First Time Cruiser?" name="first-time-cruiser">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Primary Traveler Information"/>&#13;
		<field type="radio-group" required="true" label="Gender" name="gender">&#13;
			<option label="F" value="f">F</option>&#13;
			<option label="M" value="m">M</option>&#13;
			<option label="X" value="x">X</option>&#13;
		</field>&#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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred Name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State of Residence" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Date of Birth and MISC."/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="checkbox-group" label="Promotional Qualifiers" description="Promotional Qualifiers" name="promotional-qualifiers">&#13;
			<option label="Military" value="military">Military</option>&#13;
			<option label="Senior (55+)" value="senior-55">Senior (55+)</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Email Address" description="Primary guest&#39;s email and phone number are required on all bookings to ensure you receive the most up to date information about the sailing and any pre-cruise requirements you must complete." name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone Number" description="Primary guest&#39;s email and phone number are required on all bookings to ensure you receive the most up to date information about the sailing and any pre-cruise requirements you must complete." name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Carnival VIFP Number (for Past Carnival Guests)"/>&#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="radio-group" label="Are you celebrating a special occasion for this cruise?" name="are-you-celebrating-a-special-occasion-for-this-cruise">&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Family Getaway" value="family-getaway">Family Getaway</option>&#13;
			<option label="Fun Getaway" value="fun-getaway">Fun Getaway</option>&#13;
			<option label="Retirement Celebration" value="retirement-celebration">Retirement Celebration</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="DATES" placeholder=" " name="dates" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Cruise Duration" name="over-age-55">&#13;
			<option label="2 - 5 Days" value="2-5-days">2 - 5 Days</option>&#13;
			<option label="6 - 9 Days" value="6-9-days">6 - 9 Days</option>&#13;
			<option label="10+ Days" value="10-days">10+ Days</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="SAIL TO" placeholder="Ex: The Bahamas / Caribbean" name="desired-destinations" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Cruise Departure Port (Click All That Apply)" inline="true" name="military">&#13;
			<option label="Baltimore MD" value="baltimore-md">Baltimore MD</option>&#13;
			<option label="Charleston SC" value="charleston-sc">Charleston SC</option>&#13;
			<option label="Galveston TX" value="galveston-tx">Galveston TX</option>&#13;
			<option label="Jacksonville FL" value="jacksonville-fl">Jacksonville FL</option>&#13;
			<option label="Los Angeles CA" value="los-angeles-ca">Los Angeles CA</option>&#13;
			<option label="Miami FL" value="miami-fl">Miami FL</option>&#13;
			<option label="Mobile AL" value="mobile-al">Mobile AL</option>&#13;
			<option label="New Orleans LA" value="new-orleans-la">New Orleans LA</option>&#13;
			<option label="New York NY" value="new-york-ny">New York NY</option>&#13;
			<option label="Norfolk VA" value="norfolk-va">Norfolk VA</option>&#13;
			<option label="Orlando FL" value="orlando-fl">Orlando FL</option>&#13;
			<option label="San Francisco CA" value="san-francisco-ca">San Francisco CA</option>&#13;
			<option label="Seattle WA" value="seattle-wa">Seattle WA</option>&#13;
			<option label="Tampa FL" value="tampa-fl">Tampa FL</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="CABIN TYPE" name="cabin-type">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Outside View" value="outside-view">Outside View</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do You Need A Wheelchair, Powerchair or Scooter Accessible Cabin?" name="do-you-need-a-wheelchair-powerchair-or-scooter-accessible-cabin">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Medical" description="Wheelchair Assistance Is Only Available For Embarkation and Debarkation when Guest Is Not Bringing Their Own Wheelchair" name="medical">&#13;
			<option label="WHEELCHAIR ASSISTANCE" value="wheelchair-assistance">WHEELCHAIR ASSISTANCE</option>&#13;
			<option label="WHEELCHAIR" value="wheelchair">WHEELCHAIR</option>&#13;
			<option label="ALLERGIES" value="allergies">ALLERGIES</option>&#13;
			<option label="AUTISM" value="autism">AUTISM</option>&#13;
			<option label="BLIND OR LOW VISION" value="blind-or-low-vision">BLIND OR LOW VISION</option>&#13;
			<option label="COGNITIVE DISABILITIES" value="cognitive-disabilities">COGNITIVE DISABILITIES</option>&#13;
			<option label="CONCENTRATOR" value="concentrator">CONCENTRATOR</option>&#13;
			<option label="DEAF" value="deaf">DEAF</option>&#13;
			<option label="DIABETIC" value="diabetic">DIABETIC</option>&#13;
			<option label="DIALYSIS" value="dialysis">DIALYSIS</option>&#13;
			<option label="OTHER (LEAVE DETAILS BELOW)" value="other-leave-details-below">OTHER (LEAVE DETAILS BELOW)</option>&#13;
			<option label="OXYGEN" value="oxygen">OXYGEN</option>&#13;
			<option label="PREGNANT LESS THAN 24 WEEKS" value="pregnant-less-than-24-weeks">PREGNANT LESS THAN 24 WEEKS</option>&#13;
			<option label="PREGNANT MORE THAN 24 WEEKS" value="pregnant-more-than-24-weeks">PREGNANT MORE THAN 24 WEEKS</option>&#13;
			<option label="SHARPS CONTAINER" value="sharps-container">SHARPS CONTAINER</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What Time Would You Like To Dine In The Main Dining Room?" name="what-time-would-you-like-">&#13;
			<option label="Early Dining" value="early-dining">Early Dining</option>&#13;
			<option label="Late Dining" value="late-dining">Late Dining</option>&#13;
			<option label="Anytime Dining" value="anytime-dining">Anytime Dining</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Would you like to add the following after Booking?" name="checkbox-group-1709430566056">&#13;
			<option label="Drink Package" value="drink-package">Drink Package</option>&#13;
			<option label="Internet" value="internet">Internet</option>&#13;
			<option label="Photo Packages" value="photo-packages">Photo Packages</option>&#13;
			<option label="Shore Excursions" value="shore-excursions">Shore Excursions</option>&#13;
			<option label="Specialty Dining" value="specialty-dining">Specialty Dining</option>&#13;
		</field>&#13;
		<field type="radio-group" label="How did you hear about us?" name="radio-group-1709430572423">&#13;
			<option label="YouTube" value="youtube">YouTube</option>&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Google" value="google">Google</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" label="Additional Information:" name="additional-information" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="TRAVEL INSURANCE"/>&#13;
		<field type="paragraph" subtype="p" label="By signing below, 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.&amp;nbsp;"/>&#13;
		<field type="radio-group" required="true" label="&amp;nbsp;Please choose:*" name="-please-choose">&#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>

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="radio-group" required="true" label="First Time Cruiser?" name="first-time-cruiser">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Traveler Information"/>&#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="x">X</option>&#13;
		</field>&#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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred Name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone Number" description="Primary guest&#39;s email and phone number are required on all bookings to ensure you receive the most up to date information about the sailing and any pre-cruise requirements you must complete." name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email Address" description="Primary guest&#39;s email and phone number are required on all bookings to ensure you receive the most up to date information about the sailing and any pre-cruise requirements you must complete." name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State of Residence?" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Promotional Qualifiers" description="Promotional Qualifiers" name="promotional-qualifiers">&#13;
			<option label="Age 55+" value="age-55">Age 55+</option>&#13;
			<option label="U.S. or Canadian Law Enforcement" value="us-or-canadian-law-enforcement">U.S. or Canadian Law Enforcement</option>&#13;
			<option label="Fire Department or EMT" value="fire-department-or-emt">Fire Department or EMT</option>&#13;
			<option label="U.S. Military or Canadian Forces" value="us-military-or-canadian-forces">U.S. Military or Canadian Forces</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Carnival VIFP#&amp;nbsp;"/>&#13;
		<field type="clientLoyaltyPrograms" label="Carnival VIFP# Number (For Carnival Past Guest)" 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="radio-group" label="Are you celebrating a special occasion for this cruise?" name="are-you-celebrating-a-special-occasion-for-this-cruise">&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Family Getaway" value="family-getaway">Family Getaway</option>&#13;
			<option label="Fun Getaway" value="fun-getaway">Fun Getaway</option>&#13;
			<option label="Retirement Celebration" value="retirement-celebration">Retirement Celebration</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Do You Need A Wheelchair, Powerchair or Scooter Accessible Cabin" name="military">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="SPECIAL REQUESTS"/>&#13;
		<field type="checkbox-group" label="MEDICAL NEEDS" description="Wheelchair Assistance Is Only Available for Embarkation and Debarkation When The Guest DOES NOT Bring Their Own Wheelchair" name="medical-needs">&#13;
			<option label="WHEELCHAIR ASSISTANCE" value="wheelchair-assistance">WHEELCHAIR ASSISTANCE</option>&#13;
			<option label="AUTISM" value="autism">AUTISM</option>&#13;
			<option label="ALLERGIES" value="allergies">ALLERGIES</option>&#13;
			<option label="BLIND OR LOW VISION" value="blind-or-low-vision">BLIND OR LOW VISION</option>&#13;
			<option label="COGNITIVE DISABILITIES" value="cognitive-disabilities">COGNITIVE DISABILITIES</option>&#13;
			<option label="CONCENTRATOR" value="concentrator">CONCENTRATOR</option>&#13;
			<option label="DEAF" value="deaf">DEAF</option>&#13;
			<option label="DIABETIC" value="diabetic">DIABETIC</option>&#13;
			<option label="DIALYSIS" value="dialysis">DIALYSIS</option>&#13;
			<option label="FOOD ALLERGIES or DIET (Explain in Notes Below)" value="food-allergies-or-diet-explain-in-notes-below">FOOD ALLERGIES or DIET (Explain in Notes Below)</option>&#13;
			<option label="OXYGEN" value="oxygen">OXYGEN</option>&#13;
			<option label="PREGNANT LESS THAN 24 FULL WEEKS" value="pregnant-less-than-24-full-weeks">PREGNANT LESS THAN 24 FULL WEEKS</option>&#13;
			<option label="PREGNANT MORE THAN 24 FULL WEEKS" value="pregnant-more-than-24-full-weeks">PREGNANT MORE THAN 24 FULL WEEKS</option>&#13;
			<option label="SHARPS CONTAINER" value="sharps-container">SHARPS CONTAINER</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What Time Would You Like To Dine In The Main Dining Room?" name="what-time-would-you-like-to-dine-in-the-main-dining-room">&#13;
			<option label="Early Dining" value="early-dining">Early Dining</option>&#13;
			<option label="Late Dining" value="late-dining">Late Dining</option>&#13;
			<option label="Anytime Dining" value="anytime-dining">Anytime Dining</option>&#13;
		</field>&#13;
		<field type="textarea" label="MESSAGE TO AGENT" name="message-to-agent" className="form-control"/>&#13;
		<field type="textarea" label="TRAVEL INSURANCE" name="travel-insurance" value="By signing below  I fully 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." className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Please Choose" name="please-choose">&#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>

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="radio-group" required="true" label="First Time Cruiser?" name="first-time-cruiser">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Traveler Information"/>&#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="x">X</option>&#13;
		</field>&#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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred Name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone Number" description="Primary guest&#39;s email and phone number are required on all bookings to ensure you receive the most up to date information about the sailing and any pre-cruise requirements you must complete." name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Email Address" description="Primary guest&#39;s email and phone number are required on all bookings to ensure you receive the most up to date information about the sailing and any pre-cruise requirements you must complete." name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State of Residence?" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Promotional Qualifiers" description="Promotional Qualifiers" name="promotional-qualifiers">&#13;
			<option label="Age 55+" value="age-55">Age 55+</option>&#13;
			<option label="U.S. or Canadian Law Enforcement" value="us-or-canadian-law-enforcement">U.S. or Canadian Law Enforcement</option>&#13;
			<option label="Fire Department or EMT" value="fire-department-or-emt">Fire Department or EMT</option>&#13;
			<option label="U.S. Military or Canadian Forces" value="us-military-or-canadian-forces">U.S. Military or Canadian Forces</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Carnival VIFP#&amp;nbsp;"/>&#13;
		<field type="clientLoyaltyPrograms" label="Carnival VIFP# Number (For Carnival Past Guest)" 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="radio-group" label="Are you celebrating a special occasion for this cruise?" name="are-you-celebrating-a-special-occasion-for-this-cruise">&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Family Getaway" value="family-getaway">Family Getaway</option>&#13;
			<option label="Fun Getaway" value="fun-getaway">Fun Getaway</option>&#13;
			<option label="Retirement Celebration" value="retirement-celebration">Retirement Celebration</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Do You Need A Wheelchair, Powerchair or Scooter Accessible Cabin" name="military">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="SPECIAL REQUESTS"/>&#13;
		<field type="checkbox-group" label="MEDICAL NEEDS" description="Wheelchair Assistance Is Only Available for Embarkation and Debarkation When The Guest DOES NOT Bring Their Own Wheelchair" name="medical-needs">&#13;
			<option label="WHEELCHAIR ASSISTANCE" value="wheelchair-assistance">WHEELCHAIR ASSISTANCE</option>&#13;
			<option label="AUTISM" value="autism">AUTISM</option>&#13;
			<option label="ALLERGIES" value="allergies">ALLERGIES</option>&#13;
			<option label="BLIND OR LOW VISION" value="blind-or-low-vision">BLIND OR LOW VISION</option>&#13;
			<option label="COGNITIVE DISABILITIES" value="cognitive-disabilities">COGNITIVE DISABILITIES</option>&#13;
			<option label="CONCENTRATOR" value="concentrator">CONCENTRATOR</option>&#13;
			<option label="DEAF" value="deaf">DEAF</option>&#13;
			<option label="DIABETIC" value="diabetic">DIABETIC</option>&#13;
			<option label="DIALYSIS" value="dialysis">DIALYSIS</option>&#13;
			<option label="FOOD ALLERGIES or DIET (Explain in Notes Below)" value="food-allergies-or-diet-explain-in-notes-below">FOOD ALLERGIES or DIET (Explain in Notes Below)</option>&#13;
			<option label="OXYGEN" value="oxygen">OXYGEN</option>&#13;
			<option label="PREGNANT LESS THAN 24 FULL WEEKS" value="pregnant-less-than-24-full-weeks">PREGNANT LESS THAN 24 FULL WEEKS</option>&#13;
			<option label="PREGNANT MORE THAN 24 FULL WEEKS" value="pregnant-more-than-24-full-weeks">PREGNANT MORE THAN 24 FULL WEEKS</option>&#13;
			<option label="SHARPS CONTAINER" value="sharps-container">SHARPS CONTAINER</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What Time Would You Like To Dine In The Main Dining Room?" name="what-time-would-you-like-to-dine-in-the-main-dining-room">&#13;
			<option label="Early Dining" value="early-dining">Early Dining</option>&#13;
			<option label="Late Dining" value="late-dining">Late Dining</option>&#13;
			<option label="Anytime Dining" value="anytime-dining">Anytime Dining</option>&#13;
		</field>&#13;
		<field type="textarea" label="MESSAGE TO AGENT" name="message-to-agent" className="form-control"/>&#13;
		<field type="textarea" label="TRAVEL INSURANCE" name="travel-insurance" value="By signing below  I fully 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." className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Please Choose" name="please-choose">&#13;
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Credit Card Authorization

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$12.50

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Sign and agree to the terms and conditions:

Bookings must be completed within 5 days of receiving your first quote. By paying the Professional Planning fee, you acknowledge and accept these terms. I authorize Playtime Travel Co. to charge the credit/debit card provided, knowing that this fee is non-refundable and it will not be applied towards your booking.

** The charge will appear on your credit card statement as PAYPALTRAVEL AGENT **

** You may receive a simple email receipt from PAYPAL listing a payment to OUTSIDEAGENTS **

**Please bear in mind that any disputes by a client on a service fee charge will incur a fee for each dispute. **

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Credit Card Authorization

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