TravelJoy

Lisa Eidman

Seymour & Associates Travel

Cambodia - Vietnam with John Paul Thornton

Apr 5, 2026 to Apr 25, 2026

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information - Please complete a form for each traveler"/>&#13;
		<field type="header" subtype="h1" label="Name As It Appears On Passport"/>&#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" 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="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="Date of Birth" name="birthday" className="form-control"/>&#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="header" subtype="h1" 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" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Trip Preferences"/>&#13;
		<field type="radio-group" required="true" label="Occupancy Type" inline="true" name="occupancy-type">&#13;
			<option label="Double Occupancy" value="double-occupancy">Double Occupancy</option>&#13;
			<option label="Single Occupancy" value="single-occupancy">Single Occupancy</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Stateroom Preference" inline="true" name="stateroom-preference">&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Category A" value="category-a">Category A</option>&#13;
			<option label="Category B" value="category-b">Category B</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Itinerary Options (choose all that apply)" name="itinerary-options-choose-all-that-apply">&#13;
			<option label="Cruise Only" value="cruise-only">Cruise Only</option>&#13;
			<option label="+ Hanoi | Ha Long Bay" value="-hanoi-ha-long-bay">+ Hanoi | Ha Long Bay</option>&#13;
			<option label="+ Siem Reap" value="-siem-reap">+ Siem Reap</option>&#13;
			<option label="+ Ho Chi Minh City" value="-ho-chi-minh-city">+ Ho Chi Minh City</option>&#13;
			<option label="+ Ho Chi Minh City | Bangkok" value="-ho-chi-minh-city-bangkok">+ Ho Chi Minh City | Bangkok</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>