TravelJoy

Christa Turner

Travelmation

Italy Escorted Tour

Aug 22, 2027 to Aug 30, 2027

Italy

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	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Italy Escorted Group Aug 22-30, 2027"/>&#13;
		<field type="header" subtype="h1" label="Please fill out the following information and I&#39;ll get your invoice out to you for your $300 deposit."/>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="text" required="true" label="Passenger #1 First&amp;nbsp; name (Legal name please)" 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 LEGAL name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name (nickname)" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Please list the person you are rooming with:" name="textarea-1785527381267" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Information"/>&#13;
		<field type="text" required="true" label="Full name as it appears (or will appear if you don&#39;t have yet) on passport" 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" required="true" label="Date of birth" name="birthday" 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="radio-group" required="true" label="Gender" name="gender">&#13;
			<option label="Female" value="female">Female</option>&#13;
			<option label="Male" value="male">Male</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Emergency Contact Information"/>&#13;
		<field type="text" required="true" label="Full name" name="emergency-contact-full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="emergency-contact-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Relationship to you" name="emergency-contact-relationship" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
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  </body>
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