TravelJoy

Diane Frisch

Diane Frisch Destinations, LLC

William Chris Rhine River Cruise

Nov 2, 2023 to Nov 9, 2023

Basel to Amsterdam

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	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>
		<field type="header" subtype="h1" label="Thank you for your interest in the Enchanting Rhine Wine Cruise with William Chris Vineyards. Please fill out the information below and you will be contacted by Diane Frisch, our travel advisor, to discuss rooming options, flight options, land extension options, and anything else you might have questions about, and then to collect your $400 per person deposit. If you have any questions, you can email Diane at dianef@dfdestinations.com.&amp;nbsp;"/>
		<field type="header" subtype="h1" label="Required Passport Information"/>
		<field type="text" label="Name exactly as it appears on your Passport" name="name-exactly-as-it-appears-on-your-passport" subtype="text" className="form-control"/>
		<field type="text" label="Nationality on Passport" name="nationality-on-passport" subtype="text" className="form-control"/>
		<field type="date" label="Date of birth as on Passport" name="date-of-birth-as-on-passport" className="form-control"/>
		<field type="date" label="Passport Expiry date (note you need pp to be valid until 6 months after you return home )" name="passport-expiry-date-note-you-need-pp-to-be-valid-until-6-months-after-you-return-home-" className="form-control"/>
		<field type="header" subtype="h1" label="Other important information"/>
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>
		<field type="text" label="Street Address" name="address-line-2" subtype="text" className="form-control"/>
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>
		<field type="text" label="Country" name="address-country" subtype="text" className="form-control"/>
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>
		<field type="text" label="Have you received the Covid vaccine?&amp;nbsp; It may or may not be required to cruise.&amp;nbsp;&amp;nbsp;" name="have-you-received-the-covid-vaccine-and-when-was-your-last-dose-it-may-or-may-not-be-required-to-cruise-" subtype="text" className="form-control"/>
		<field type="text" label="Do you have any special requirements?&amp;nbsp; Mobility impairment, dietary restrictions, need water for CPAP machine?&amp;nbsp;&amp;nbsp;" name="do-you-have-any-special-requirements-mobility-impairment-dietary-restrictions-need-water-for-cpap-machine-" subtype="text" className="form-control"/>
		<field type="text" label="Are you celebrating anything special while on this trip?" name="text-1660770746407" subtype="text" className="form-control"/>
	</fields>
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