TravelJoy

Annette M. Benjamin

sublimeXcursions LLC

2027 Mexican Riviera NYE Cruise - 2978590

Dec 27, 2026 to Jan 3, 2027

Norwegian Getaway - Cabo, Mazatlan & Puerto Vallarta

<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" 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="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="date" required="true" label="Birthday" 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;
			<option label="X" value="other">X</option>&#13;
		</field>&#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="header" subtype="h2" label="Passport Information"/>&#13;
		<field type="paragraph" subtype="p" label="A valid passport is NOT required but is always recommended. Note that ALL ADULTS must present an original birth certificate with a raised seal AND a state issued ID in lieu of a passport."/>&#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="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" 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="checkbox-group" required="true" label="Number of additional guests sailing in your cabin" name="number-of-additional-guests-sailing-in-your-cabin">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Requested Cabin Type" name="requested-cabin-type">&#13;
			<option label="Inside" value="inside">Inside</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Club Balcony" value="club-balcony">Club Balcony</option>&#13;
			<option label="Haven" value="haven">Haven</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Provide legal full name and date of birth for all additional passengers if applicable." description="Information for additional passengers." name="name-and-date-of-birth-of-passenger-3" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Provide any special requests or pertinent information." name="provide-any-special-requests-or-pertinent-information" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Please select the name of your fabulous sublimeXcursions travel agent." name="please-select-the-name-of-your-fabulous-sublimexcursions-travel-agent">&#13;
			<option label="Annette M. Benjamin" value="annette-m-benjamin">Annette M. Benjamin</option>&#13;
			<option label="Carole C. Christopher" value="carole-c-christopher">Carole C. Christopher</option>&#13;
			<option label="Kendra C Julion" value="kendra-c-julion">Kendra C Julion</option>&#13;
			<option label="Alicia S. Berkitt" value="alicia-s-berkitt">Alicia S. Berkitt</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>