<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="TRAVELER INFORMATION"/> <field type="checkbox-group" required="true" label="Select one or more options from the list below. Please note that if you do not select air, you will be responsible for booking your own airline ticket.&nbsp;" toggle="true" name="select-one-or-more-options-from-the-list-below-please-note-that-if-you-do-not-select-air-you-will-be-responsible-for-booking-your-own-air-"> <option label="Cost of Land Package Only for Double/Twin Occupancy $ 3,158pp" value="cost-of-land-package-only-for-doubletwin-occupancy-3158pp">Cost of Land Package Only for Double/Twin Occupancy $ 3,158pp</option> <option label="Cost of Land Package Only for Single Occupancy $ 4,115pp" value="cost-of-land-package-only-for-single-occupancy-4115pp">Cost of Land Package Only for Single Occupancy $ 4,115pp</option> <option label="Estimated Airline Cost $ 731pp (Flights will be booked through West Curated Travel)" value="estimated-airline-cost-731pp-flights-will-be-booked-through-west-curated-travel">Estimated Airline Cost $ 731pp (Flights will be booked through West Curated Travel)</option> <option label="Booking my own Flight" value="booking-my-own-flight">Booking my own Flight</option> </field> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field required="true" type="text" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Cell Phone Number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Emergency Contact Person and Telephone Number (do not list names of travelers that are on the trip)" name="emergency-contact-person-and-telephone-number-" subtype="text" className="form-control"/> <field type="text" required="true" label="List name and last name of traveling companion/spouse/partner (Please ensure you fill out a separate form for your traveling partner/spouse/child" name="list-name-and-last-name-of-traveling-companionspousepartner-please-ensure-you-fill-out-a-separate-form-for-your-spouse" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="PASSPORT INFORMATION"/> <field type="paragraph" subtype="p" label="If we are making an air reservation, the passenger name(s) MUST match the passport exactly in order to board the plane. If you are going through a name change, please consult your agent prior to submission.&nbsp;"/> <field type="text" required="true" label="Full name as it appears on passport (please include first, middle and last name)" name="passport-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Passport number" name="passport-number" subtype="text" className="form-control"/> <field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/> <field type="date" required="true" label="Date of issue" name="passport-date-of-issue" className="form-control"/> <field type="date" required="true" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/> <field type="radio-group" label="Gender as it appears on passport/ gov ID" name="gender"> <option label="F" value="female">F</option> <option label="M" value="male">M</option> <option label="they/them" value="theythem">they/them</option> </field> <field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="CLIENT DETAILS"/> <field type="text" required="true" label="Street Address" name="address-line-1" subtype="text" className="form-control"/> <field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="KNOWN TRAVELER NUMBERS"/> <field type="textarea" label="Enter your airline, TSA, Global Entry ID program numbers, etc." name="enter-your-airline-tsa-global-entry-id-program-numbers-etc" className="form-control"/> <field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/> <field type="header" subtype="h1" label="CLIENT PREFERENCES"/> <field type="radio-group" label="Please select the airport from which you will depart the USA &nbsp;if you have selected flights to be included in your package." name="please-select-the-airport-from-which-you-will-depart-the-usa-groups-only-"> <option label="New York (10 Seats)" value="new-york-10-seats">New York (10 Seats)</option> <option label="Miami (50 Seats)" value="miami-50-seats">Miami (50 Seats)</option> <option label="Atlanta (60 Seats)" value="atlanta-60-seats">Atlanta (60 Seats)</option> </field> <field type="radio-group" label="Seat preference (Please note that seat requests are not guaranteed and are at the discretion of the airline and cannot be changed). In some cases seats will be assigned at the airport.&nbsp;" description="Please note these seats request cannot be guaranteed" name="seat-preference"> <option label="Window" value="window">Window</option> <option label="Aisle" value="aisle">Aisle</option> <option label="Opposite aisle" value="opposite aisle">Opposite aisle</option> </field> <field type="textarea" label="List any allergies&nbsp;" name="please-list-any-allergies-aversions-that-we-should-be-aware-of" className="form-control"/> <field type="text" required="true" label="List the name and last name of your roommate&nbsp;" name="list-the-name-and-last-name-of-your-roommate-" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Room Selection" name="room-selection"> <option label="Single room (1 Bed for 1 traveler)" value="single-room-1-bed-for-1-traveler">Single room (1 Bed for 1 traveler)</option> <option label="Double (1 Bed for 2 travelers)" value="double-1-bed-for-2-travelers">Double (1 Bed for 2 travelers)</option> <option label="Twin beds (2 Beds for 2 travelers )" value="twin-beds-2-beds-for-2-travelers-">Twin beds (2 Beds for 2 travelers )</option> </field> <field type="header" subtype="h1" label="Membership (For groups only)"/> <field type="radio-group" required="true" label="Please select from the list below your association with the Council&nbsp;" name="please-select-from-the-list-below-your-association-with-the-nba-judicial-council-"> <option label="Member " value="member-">Member </option> <option label="Non Member " value="non-member-">Non Member </option> </field> <field type="text" label="If you have selected non-member from the list above, please provide the name and contact number of the referring member (Groups Only)" name="if-you-have-selected-nonmember-from-the-list-above-please-provide-the-name-and-contact-number-of-the-referring-member-groups-only" subtype="text" className="form-control"/> </fields> </form-template> </body> </html>
SUBMIT PROFILE
American Airlines (AAdvantage)
United Airlines (Mileage Plus)
Delta Air Lines (SkyMiles)
Hilton (Honors)
Marriott Bonvoy
Southwest Airlines (Rapid Rewards)
IHG Rewards Club
Hyatt (World of Hyatt)
JetBlue Airways (trueBlue)
British Airways (Executive Club)
Alaska Airlines (Mileage Plan)
Hertz Gold Plus Rewards
Virgin America (eleVAte)
Club Carlson Hotels
Avis (Preferred)
Amtrak (Guest Rewards)
National (Emerald Club)
Wyndham Rewards (Days Inn, etc.)
Hawaiian Airlines (HawaiianMiles)
Choice Hotels (Choice Privileges)
Frontier Airlines (EarlyReturns)
Best Western Rewards
Lufthansa (Miles and More)
Virgin Atlantic (Flying Club)
Air Canada Aeroplan
Enterprise Rent-A-Car
Korean Air (SkyPass)
Air France (Flying Blue)
Singapore Airlines (KrisFlyer)
Emirates (Skywards)
Spirit Airlines (Free Spirit)
Le Club Accorhotels (Accor Hotels, Novotel, etc.)
Hotels.com Rewards
All Nippon Airways (ANA Mileage Club)
Cathay Pacific (Asia Miles)
Fairmont President's Club
Qantas (Frequent Flyer)
Budget (Fastbreak)
La Quinta, etc. (Returns)
Iberia Plus
Kimpton (Karma Rewards)
Asiana Airlines (Asiana Club)
Omni Hotels (Select Guest)
AviancaTaca (LifeMiles)
Alamo
Etihad Airways (Etihad Guest)
Aegean Airlines (Miles & Bonus)
KLM (Flying Blue)
MGM Resorts (M life Players Club)
Japan Airlines (JMB)
AirBerlin (Topbonus)
LATAM (LATAM Pass)
Thrifty (Blue Chip Rewards)
Royal Caribbean (Crown & Anchor Society)
Alitalia (MilleMiglia)
Qatar Airways (Qmiles)
Jet Airways (JetPrivilege)
Turkish Airlines (Miles&Smiles)
Icelandair (Saga Club)
Dollar Rent A Car (Express)
Carnival (VIFP)
Eva Air (Infinity MileageLands)
Sun Country Airlines (Ufly Rewards)
Shangri-La (Golden Circle)
Air India (Flying Returns)
Sixt Rent-a-Car
BMI (Diamond Club)
Booking.com
Loews Hotels (YouFirst Rewards)
Norwegian Air Shuttle ASA (Norwegian Reward)
Stash Hotel Rewards
Scandinavian Airlines System (EuroBonus)
Norwegian Cruise Line (Latitudes)
Aeromexico (Club Premier)
Copa Airlines ConnectMiles (Prefer)
Celebrity Cruises (Captain's Club)
Drury Hotels (Gold Key Club)
Aer Lingus (Gold Circle)
Virgin Australia (Velocity Frequent Flyer)
EL AL Israel Airlines (Matmid)
Princess Cruise Lines (Captain Circle)
China Airlines (Dynasty Flyer)
Delta (SkyBonus Corporate)
Melia (Melia Rewards)
GHA (Discovery)
Air China (PhoenixMiles)
Air Asia (BIG)
Gol Airlines (Smiles)
Malaysia Airlines (Enrich)
Air New Zealand (Airpoints)
WestJet (Frequent Guest)
Porter (VIPorter)
Agoda Rewards
Thai Airways (Royal Orchid Plus)
VOILÀ Hotel Rewards
Preferred Hotels, etc. (iPrefer)
Red Roof Inn (RediCard)
Aeroflot Bonus
China Eastern (Eastern Miles)
Holland America Line (Mariner Society)
Philippine Airlines (Mabuhay Miles)
Bangkok Airways (FlyerBonus)
Hilton Grand Vacations (Club)
South African Airways (Voyager)
China Southern (Sky Pearl)
Finnair Plus
Small Luxury Hotels (The Club)
TAP Portugal (Victoria Miles)
Avianca (Amigo)
Langham Hotels (1865 Club)
Fox Rent A Car (Rewards)
Hainan Airlines (Fortune Wings)
AmericInn (Easy Rewards)
Disney Cruise Line (Castaway Club)
Payless Car Rental (Perks Club)
Azul (TudoAzul)
Starwood Hotels (Preferred Business)
My Europcar (Privilege)
Hyatt (Vacation Club)
Aerolineas Argentinas (Plus)
Taj (InnerCircle)
British Airways (On Business, Corporate)
Leading Hotels of the World (Leaders Club)
Eurostar Frequent Traveler
Red Lion (Hello Rewards)
Air Tahiti Nui (Club Tiare)
United PerksPlus (Corporate Program)
NH Hotels (NH World)
Swissotel Circle
Millennium & Copthorne (My Millennium)
Ethiopian Airlines (ShebaMiles)
Royal Air Maroc (Safar Flyer)
Alaska Airlines (EasyBiz Corporate)
Vueling Airlines (Punto Punto)
Gulf Air (Falconflyer)
Star Alliance Company (PlusAwards)
Coast Hotels (Coast Rewards)
Royal Jordanian Airlines (Royal Plus)
HotelClub (Member Rewards)
Czech Airlines (OK Plus)
VIA Rail Canada (VIA Preference)
Trump Card (Privileges Program)
Borgata (Rewards)
Saudi Arabian Airlines (Alfursan)
Vietnam Airlines (Golden Lotus Plus)
Egypt Air Plus
Scandic Hotels (Scandic Friends)
JetBlue Airways (CompanyBlue)
Hostelworld (My World)
Jumeirah (Sirius)
E-Z Rent-A-Car (E-Z Money)
Deutsche Bahn (BahnCard)
Garuda (Frequent Flyer)
TripAdvisor
Kuwait Airways (Oasis Club)
Cosmopolitan Hotels (Identity)
Advantage Rent a Car (Instant Rewards)
Cayman Airways (Sir Turtle Rewards)
Caribbean Airlines (Caribbean Miles)
RIU Hotels & Resorts (RIU Class)
Easyjet
SriLankan (FlySmiLes)
TabletHotels (Reward Dollars)
Ace Rent a Car
Thalys (The Card)
S7 Priority
Air Baltic (Pins)
Choice Hotels (Nordic Choice Club)
Trident Hotels (Trident Privilege)
Middle East Airlines (Cedar Miles)
Emirates for Kids (Skysurfer)
Rydges (PriorityGUEST)
Oman Air (Sindbad)
Island Air (Cloud 9)
Ukraine International Airlines (Panorama Club)
Flybe (Rewards4all)
SNCF (Voyageur)
Marriott Gift Cards
Qantas (Aquire)
Pegasus Airlines (Pegasus Plus)
Air Transat
Silver Cloud (Rewards)
Brussels Airlines (LOOPs)
JAL Hotels (One Harmony)
Eurowings (Boomerang)
Azamara (Le Club Voyage)
Otel.com (FivePlus)
Meridiana Fly (Hi-Fly)
Prince Resorts Hawaii (Prince Preferred)
PIA (Awards Plus)
Air Astana (Nomad Club)
Regal Hotels (Regal Rewards)
IndiGo
Era Alaska (FlyAway Rewards)
Red Spotted Hanky (Loyalty points)
Thon Hotels (Thon Member)
Air Jamaica (Seventh Heaven)
Trenitalia (FrecciaClub)
Air Malta (Flypass)
Splendia (Club Rewards)
Dorint (Card)
UTair (Status)
Tsogo Sun (Frequent Guest)
Sino Hotel Group (IPrestige)
KLM BlueBiz (Corporate)
RZD (Bonus)
Elite Hotels of Sweden
New Otani (Club International)
Air Algérie (Air Algérie Plus)
Ryanair
The Montcalm & Shaftsbury (Premier Club)
Dan Hotels (e-dan club)
Pestana Priority Guest
Macdonald Hotels (The Club)
Air Mauritius (Kestrelflyer)
Frasers Hospitality (Fraser World)
AirBerlin (business points)
Park-N-Go (Frequent Parker Rewards)
Localiza Rent a Car
Jurys Inn (Jurys Rewards)
Air Caraibes (Preference)
Bulgaria Air (Fly More)
Air Niugini (Destinations)
TUIfly.com
Cebu Pacific (Getgo)
Premier Hotels (Premier Club)
Jet2.com (My Jet2)
Air Austral (My Capricorne)
CAT (C-Club)
Opinion Miles Club
Ural Airlines (Wings)
Air Europa (SUMA)
Monarch (Vantage Club)
Stena Line (Extra)
La Compagnie (My Compagnie)
First Hotels (First Member)
Belavia (Leader)
Azerbaijan Airlines (Azal Miles)
Wizz Air (Discount Club)
Tunisair (Fidelys)
Paradores (Amigos de Paradores)
Vistara (Vistara Club)
Montenegro Airlines (Vision Team)
Asky Airlines (ASKY Club)
Jinling Hotels (Elite)
Moby Lines (Moby Club)
Jin Jiang Group (J-Club)
AtlasGlobal (AtlasMiles)
Qubus Hotel (Q-Club)
Braathens Regional Airlines (BRA Friends )
Hotelbooker.org
Flynas (NaSmiles)
Czech Airlines (OK Plus Corporate)
Uzbekistan Airways (UzAirPlus)
TAAG Angola Airlines (Umbi Umbi Club)
Yelloh! Village (Yelloh! Plus)
Future Inns (Rewards Club)
Nordavia (Golden Mile)
Air Arabia (Airewards)
Royal Brunei Airlines (Royal Skies)
Leonardo Hotels (AdvantageCLUB)
Air Moldova Club
Air Cote D'Ivoire (sMiles)
Air Macau (Privileges)
Etihad (BusinessConnect)
Gloria Hotels & Resorts (Gloria Partner)
Santos Hotels (Club Santos)
Known Traveler Number (KTN)
Global Entry ID
TSA PreCheck
NEXUS ID
SENTRI ID
American Automative Association (AAA)
Sandals Select Guest (SSG)
Mandarin Oriental Fan
Relais and Chateaux 5C
Four Seasons Preferred
Dorchester Diamond
Peninsula Pen
Belmond Bellini
Silversea Venetian
Oceania Cruise Lines
Regent Cruise Line
Seabourn Cruise Line
Lindblad Expeditions
SeaDream Yacht Club
Cunard
Virgin Voyages Sailing Club
AmaWaterways