TravelJoy

Terri Moore

Far Moore Travel

2024- Ultimate South Africa

Oct 28, 2024 to Nov 8, 2024

South Africa

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		<field type="header" subtype="h3" label="Complete one form per person when you are ready to pay your deposit. Although a valid Passport is required for travel, you do not have to enter your Passport information into this form in order to submit it, however, a copy of your Passport is required within 60 days of departure. Rates and availability are subject to change until a deposit is paid"/>&#13;
		<field type="checkbox-group" required="true" label="Departure Airport (rate will be provided for alternate airports)" name="departure-airport" other="true">&#13;
			<option label="Washington Dulles (IAD)" value="washington-dulles-iad">Washington Dulles (IAD)</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Room Occupancy" name="room-occupancy">&#13;
			<option label="Single (1 person in the room)" value="single-1-person-in-the-room">Single (1 person in the room)</option>&#13;
			<option label="Double (2 people in the room)" value="double-2-people-in-the-room">Double (2 people in the room)</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Package Type" name="package-type">&#13;
			<option label="Golfer" value="golfer">Golfer</option>&#13;
			<option label="Non-Golfer" value="nongolfer">Non-Golfer</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Passenger Info"/>&#13;
		<field type="text" label="Prefix" name="prefix" 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" required="true" label="Middle name" description="If no middle name  type &quot;none&quot;" 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="Suffix" name="suffix" subtype="text" 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="date" label="Birthday" name="birthday" 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" label="Country" name="address-country" 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="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Info"/>&#13;
		<field type="text" label="Full name as it appears on passport" description="Passport must be valid for six (6) months after travel ends and have 2 blank pages back to back. Please provide a copy of your passport prior to the final payment date" 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="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Known Traveler Number /TSA Pre-Check" name="known-traveler-number-tsa-precheck" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Emergency Contact Information"/>&#13;
		<field type="text" required="true" label="Emergency Contact Name" name="emergency-contact-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Emergency Contact Number" name="emergency-contact-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Roommate's Name (Enter N/A if Single Occupancy)" name="roommates-name-enter-na-if-single-occupancy" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Invoice Type" name="invoice-type">&#13;
			<option label="Separate Invoices" value="separate-invoices">Separate Invoices</option>&#13;
			<option label="One Invoice for all guests sharing the room" value="one-invoice-for-all-guests-sharing-the-room">One Invoice for all guests sharing the room</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Travel Insurance" description="Actual cost of insurance based on trip cost and traveler's age" name="travel-insurance--89-per-person">&#13;
			<option label="Provide a Quote" value="provide-a-quote">Provide a Quote</option>&#13;
			<option label="Declined" value="declined">Declined</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Package Upgrades"/>&#13;
		<field type="checkbox-group" label="Airfare (rates vary according to departure airport)" name="airfare">&#13;
			<option label="Business Class: Additional $6,400 per person from Washington Dulles" value="business-class-additional-6400-per-person-from-washington-dulles">Business Class: Additional $6,400 per person from Washington Dulles</option>&#13;
			<option label="Business Class: Additional $7,895 per person from Boston" value="business-class-additional-7895-per-person-from-boston">Business Class: Additional $7,895 per person from Boston</option>&#13;
			<option label="Business Class: Additional $6,635 per person from Norfolk" value="business-class-additional-6635-per-person-from-norfolk">Business Class: Additional $6,635 per person from Norfolk</option>&#13;
			<option label="Business Class: Additional $9,590 per person from Phoenix" value="business-class-additional-9590-per-person-from-phoenix">Business Class: Additional $9,590 per person from Phoenix</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Hotel Room: Sandton Sun Johannesburg- Suite" name="hotel-room-sandton-sun-johannesburg-suite">&#13;
			<option label="Single Occupancy- $870" value="single-occupancy-870">Single Occupancy- $870</option>&#13;
			<option label="Double $435 pp" value="double-435-pp">Double $435 pp</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Hotel Room: Palace Hotel Sun City- Jr. Suite" name="hotel-room-palace-hotel-sun-city-jr-suite">&#13;
			<option label="Single Occupancy- $145" value="single-occupancy-145">Single Occupancy- $145</option>&#13;
			<option label="Double $100 pp" value="double-100-pp">Double $100 pp</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="radio-group" label="Seat preference" name="seat-preference">&#13;
			<option label="Window" value="window">Window</option>&#13;
			<option label="Middle" value="middle">Middle</option>&#13;
			<option label="Aisle" value="aisle">Aisle</option>&#13;
			<option label="Opposite Aisle" value="opposite-aisle">Opposite Aisle</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen/Twin" value="2-doublequeentwin">2 Double/Queen/Twin</option>&#13;
		</field>&#13;
		<field type="text" label="Food Allergies" name="meal-preference" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Special Needs (Accessibility, Traveling with a Cpap Machine, etc)" name="special-needs-accessibility-traveling-with-a-cpap-machine-etc" subtype="text" className="form-control"/>&#13;
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