TravelJoy

LaTricia Dugger

JET Travel & Tours

Memphis-Home of the Blues, Soul & Rock n Roll

Apr 6, 2024 to Apr 14, 2024

Memphis, TN

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		<field type="header" subtype="h1" label="Memphis Motorcoach Hosted Group Tour&amp;nbsp;"/>&#13;
		<field type="paragraph" subtype="p" label="We're thrilled you're interested in discovering&amp;nbsp; Memphis with us on our upcoming Memphis Motorcoach Hosted Group Tour! To get started with your booking, kindly provide us with your details below. By completing and submitting this form, you are authorizing our agency to contact you with additional details related to this trip."/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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="text" required="true" label="Please list the name of anyone you would like to room with on this trip" placeholder="e.g. John Doe Sr." name="please-list-the-name-of-anyone-you-would-like-to-room-with-on-this-trip" subtype="text" 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" 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="h2" label="&amp;nbsp;Additional Information"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="text" required="true" label="&amp;nbsp;Dietary Restrictions:" description="e.g. vegetarian  etc." placeholder="e.g. vegetarian  etc." name="-dietary-restrictions" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Please list any special needs." placeholder="e.g. will need a wheelchair  I use a CPAP  etc." name="please-list-any-special-needs" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are you interested in travel insurance for this trip?" name="are-you-interested-in-travel-insurance-for-this-trip">&#13;
			<option label="Yes. I'd like to know more." value="yes-id-like-to-know-more">Yes. I'd like to know more.</option>&#13;
			<option label="No, thank you" value="no-thank-you">No, thank you</option>&#13;
		</field>&#13;
		<field type="text" label="Are you celebrating any special events?" placeholder="e.g. wedding anniversary   wife's birthday  etc." name="are-you-celebrating-any-special-events" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Please add any additional information we need to know:" name="please-add-any-additional-information-we-need-to-know" className="form-control"/>&#13;
		<field type="select" required="true" label="How would you like to pay for the deposit this trip, cash or check? (Please Note: Bookings are not secured until check is received at our main office located at 220 Main St. W. Ashland, WI 54806)" name="how-would-you-like-to-pay-for-the-deposit-this-trip-cash-or-check-please-note-bookings-are-not-secured-until-check-is-received-at-our-main-office-located-at-220-main-st-w-ashland-wi-54806" className="form-control">&#13;
			<option label="Select Here" value="select-here">Select Here</option>&#13;
			<option label="By check. Please mail or submit to our main office." value="by-check-please-mail-or-submit-to-our-main-office">By check. Please mail or submit to our main office.</option>&#13;
			<option label="Cash only. Please stop by our office to submit payment." value="cash-only-please-stop-by-our-office-to-submit-payment">Cash only. Please stop by our office to submit payment.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Emergency Contact Information"/>&#13;
		<field type="text" required="true" label="Emergency Contact - First &amp;amp; Last Name&amp;nbsp;" name="emergency-contact-first-last-name-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Emergency Contact - Phone" placeholder="715-292-1234" name="emergency-contact-phone" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
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  </body>
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