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PushPin Adventures

Carnival Breeze Group

May 28, 2026 to Jun 1, 2026

Galveston - Cozumel Mexico - Galveston

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="LEAD PASSENGER IN THIS CABIN"/>&#13;
		<field type="text" required="true" label="First name of Lead Traveler" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name of Lead Traveler" name="last-name" 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;
		</field>&#13;
		<field type="text" required="true" label="Country of Citizenship" name="country-of-citizenship" subtype="text" 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="text" label="TRAVELER 2 - ENTER FULL NAME - DATE OF BIRTH&amp;nbsp; - GENDER - NATIONALITY" description="EX - MARY JANE SMITH - 1/1/1980 - FEMALE - USA" placeholder="EX - MARY JANE SMITH - 1/1/1980 - FEMALE - USA" name="traveler-2-enter-full-name-date-of-birth-gender-nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" label="TRAVELER 3 - ENTER FULL NAME - DATE OF BIRTH&amp;nbsp; - GENDER - NATIONALITY" description="EX - MARY JANE SMITH - 1/1/1980 - FEMALE - USA" placeholder="EX - MARY JANE SMITH - 1/1/1980 - FEMALE - USA" name="traveler-3-enter-full-name-date-of-birth-gender-nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" label="TRAVELER 4 - ENTER FULL NAME - DATE OF BIRTH&amp;nbsp; - GENDER - NATIONALITY" description="EX - MARY JANE SMITH - 1/1/1980 - FEMALE - USA" placeholder="EX - MARY JANE SMITH - 1/1/1980 - FEMALE - USA" name="traveler-4-enter-full-name-date-of-birth-gender-nationality" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Your preferred cabin type&amp;nbsp;" name="your-preferred-cabin-type">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Ocean View" value="ocean-view">Ocean View</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you want to prepay gratuities?" name="do-you-want-to-prepay-gratuities">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you want a quote for travel protection" name="do-you-want-a-quote-for-travel-protection">&#13;
			<option label="Yes - I would like to cover my trip" value="yes-i-would-like-to-cover-my-trip">Yes - I would like to cover my trip</option>&#13;
			<option label="NO - do not include travel protection" value="no-do-not-include-travel-protection">NO - do not include travel protection</option>&#13;
		</field>&#13;
		<field type="text" label="Are there any medical conditions we should be aware of?" name="are-there-any-medical-conditions-we-should-be-aware-of" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>