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PushPin Adventures

Virgin Voyages LA

Apr 26, 2026 to May 3, 2026

Los Angeles - Cabo San Lucas - Mazatlan - Puerto Vallarta

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Lead Traveler for this individual reservation"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" 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" 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="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="f">F</option>&#13;
			<option label="M" value="m">M</option>&#13;
		</field>&#13;
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Additional Travelers on this Reservation"/>&#13;
		<field type="text" label="TRAVELER 2 - full name - birthday - gender - citizenship" placeholder="EX. MARY JANE SMITH - 1/1/1980 - FEMALE - USA" name="traveler-2-full-name-birthday-gender" subtype="text" className="form-control"/>&#13;
		<field type="text" label="TRAVELER 3 - full name - birthday - gender - citizenship" placeholder="EX. MARY JANE SMITH - 1/1/1980 - FEMALE - USA" name="traveler-3-full-name-birthday-gender" subtype="text" className="form-control"/>&#13;
		<field type="text" label="TRAVELER 4 - full name - birthday - gender - citizenship" placeholder="EX. MARY JANE SMITH - 1/1/1980 - FEMALE - USA" name="traveler-4-full-name-birthday-gender" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Options"/>&#13;
		<field type="radio-group" required="true" label="Which Cabin would you prefer?" name="which-cabin-would-you-prefer">&#13;
			<option label="Insider (no porthole)" value="insider-no-porthole">Insider (no porthole)</option>&#13;
			<option label="Sea View (with porthole)" value="sea-view-with-porthole">Sea View (with porthole)</option>&#13;
			<option label="Sea Terrace (with balcony)" value="sea-terrace-with-balcony" selected="selected">Sea Terrace (with balcony)</option>&#13;
			<option label="Rock Star Suite" value="rock-star-suite">Rock Star Suite</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you want travel protection?" name="do-you-want-travel-protection">&#13;
			<option label="Yes - (quote will be sent if coverage is not already part of your proposal)" value="yes-quote-will-be-sent-if-coverage-is-not-already-part-of-your-proposal">Yes - (quote will be sent if coverage is not already part of your proposal)</option>&#13;
			<option label="No - I do not want travel protection" value="no-i-do-not-want-travel-protection">No - I do not want travel protection</option>&#13;
		</field>&#13;
		<field type="textarea" label="Do you have any medical conditions we need to be aware of?" name="medical-conditions" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>