Share your information with Missy Hudgens

Missy Hudgens

Travel Connection

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    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="ICA VOYAGE CRUISE &amp;nbsp;REGISTRATION FORM"/>&#13;
		<field type="paragraph" subtype="p" label="You are one step closer to confirming your place at the 2026 ICA VOYAGE, in association with the Independent Cinema Alliance onboard the beautiful Celebrity Summit departing Ft Lauderdale on Saturday, Feb 21, 2026, for a 5-night cruise to the Bahamas, visiting Nassau and Bimini.  "/>&#13;
		<field type="paragraph" subtype="p" label="Cruise Specifics:"/>&#13;
		<field type="paragraph" subtype="p" label="• Inclusions: "/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Classic Beverage Package"/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Basic Wifi"/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Gratuities "/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Taxes"/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Fees"/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Port Charges"/>&#13;
		<field type="paragraph" subtype="p" label="• Cruise Rates – Rates below are per Cabin"/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Concierge Class Veranda -  $2311.18 Based on Double Occupancy / $2059.59 Based on Single Occupancy"/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Veranda -    $2201.18 Based on Double Occupancy / $1954.59 Based on Single Occupancy"/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Oceanview -    $1741.18 Based on Double Occupancy / $1494.59 Based on Single Occupancy"/>&#13;
		<field type="paragraph" subtype="p" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; o Prime Interior -    SOLD OUT"/>&#13;
		<field type="paragraph" subtype="p" label="• Deposit Requirement at the time of booking:  $300 per cabin"/>&#13;
		<field type="paragraph" subtype="p" label="• Final Payment due: Nov 12, 2025 "/>&#13;
		<field type="paragraph" subtype="p" label="We are so excited you will be joining us for an unforgettable experience of learning, networking, and celebrating – ICA style. "/>&#13;
		<field type="paragraph" subtype="p" label="Please complete and submit the form below, to request your cabin.  Cabin availability is based on a first come first serve basis.  Space is limited so book early. &amp;nbsp;Please note: &amp;nbsp;Completion of this form is NOT a guarantee of cabin category. &amp;nbsp;"/>&#13;
		<field type="paragraph" subtype="p" label="If you have any questions regarding accommodation, please do not hesitate to contact:"/>&#13;
		<field type="paragraph" subtype="p" label="Missy Hudgens, CTA"/>&#13;
		<field type="paragraph" subtype="p" label="Travel Connection"/>&#13;
		<field type="paragraph" subtype="p" label="missy@trvlconnetion.com"/>&#13;
		<field type="paragraph" subtype="p" label="706-550-5727"/>&#13;
		<field type="header" subtype="h1" label="____________________________________________________________"/>&#13;
		<field type="radio-group" required="true" label="HAVE YOU REGISTERED AND RECEIVED CONFIRMATION FOR ICA VOYAGE CONFERNCE?" name="have-you-registered-and-received-confirmation-for-ica-voyage-confernce">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="PASSENGER #1"/>&#13;
		<field type="paragraph" subtype="p" label="Please list names exactly as they appear on Passport"/>&#13;
		<field type="radio-group" required="true" label="Prefix - Passenger #1" name="prefix-passenger-2">&#13;
			<option label="MR" value="mr">MR</option>&#13;
			<option label="MRS" value="mrs">MRS</option>&#13;
			<option label="MISS" value="miss">MISS</option>&#13;
			<option label="MASTER" value="master">MASTER</option>&#13;
			<option label="MS" value="ms">MS</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="First name (As it appears on passport)" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name (As it appears on passport)" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name (As it appears on passport)" 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="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="header" subtype="h1" 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="h1" label="PASSPORT INFORMATION"/>&#13;
		<field type="radio-group" required="true" label="Will you be traveling with a Passport?" name="will-you-be-traveling-with-a-passport" other="true">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="PLEASE NOTE: &amp;nbsp;If more than one person traveling, please ensure all passport ID pages are on the same copy page or email 2nd Passenger Passport copy to Missy@trvlconnection.com."/>&#13;
		<field type="file" label="Photo of passport ID page" description="If more than one person traveling  please ensure all passport ID pages are on the same copy page." name="passport_photo" subtype="file" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="CABIN INFORMATION"/>&#13;
		<field type="radio-group" required="true" label="Occupancy" name="occupancy">&#13;
			<option label="Double" value="double">Double</option>&#13;
			<option label="Single" value="single">Single</option>&#13;
			<option label="OTHER - Please Contact Travel Connection" value="other-please-contact-travel-connection">OTHER - Please Contact Travel Connection</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Cabin Category &amp;nbsp;(SELECT ONE)" name="cabin-category-">&#13;
			<option label="Aqua Class Veranda" value="aqua-class-veranda">Aqua Class Veranda</option>&#13;
			<option label="Concierge Class Veranda" value="concierge-class-veranda">Concierge Class Veranda</option>&#13;
			<option label="Veranda" value="veranda">Veranda</option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Prime Interior - SOLD OUT" value="prime-interior-sold-out">Prime Interior - SOLD OUT</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="PASSENGER #2"/>&#13;
		<field type="paragraph" subtype="p" label="Please list names exactly as they appear on Passport"/>&#13;
		<field type="radio-group" label="Prefix - Passenger #2" name="radio-group-1750194739749">&#13;
			<option label="MR" value="mr">MR</option>&#13;
			<option label="MRS" value="mrs">MRS</option>&#13;
			<option label="MISS" value="miss">MISS</option>&#13;
			<option label="MASTER" value="master">MASTER</option>&#13;
			<option label="MS" value="ms">MS</option>&#13;
		</field>&#13;
		<field type="text" label="First Name &amp;nbsp;- Passenger #2" name="first-name-passenger-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle Name - Passenger #2" name="middle-name-passenger-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Last Name - Passenger #2" name="last-name-passenger-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Suffix - Passenger #2" name="suffix-passenger-2" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Birthdate - Passenger #2" name="birthdate" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="PAYMENT INFORMATION"/>&#13;
		<field type="radio-group" required="true" label="Who is responsible for the deposit?" name="who-is-responsible-for-the-deposit">&#13;
			<option label="I will be responsible for paying for the cruise." value="i-will-be-responsible-for-paying-for-the-cruise">I will be responsible for paying for the cruise.</option>&#13;
			<option label="My Manager/Team Leader will be responsible for paying for my cruise." value="my-managerteam-leader-will-be-responsible-for-paying-for-my-cruise">My Manager/Team Leader will be responsible for paying for my cruise.</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="If your Manager/Team Leader is responsible for paying for your cruise, please provide contact information below. &amp;nbsp;(Manager&#39;s first name and last name - Email address - Phone number) If not, please type NONE." name="if-your-managerteam-leader-is-responsible-for-paying-for-your-cruise-please-provide-contact-information-below-managers-first-name-and-last-name-email-address-phone-number-if-not-please-type-none" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Manager&#39;s Full Name:" name="managers-full-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Manager&#39;s Phone Number:" name="managers-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Manager&#39;s Email Address:" name="managers-email-address" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="MISC INFORMATION"/>&#13;
		<field type="textarea" required="true" label="Misc Information for all traveling pasengers: &amp;nbsp;Food Allergy, Medical needs (CPAP, Wheelchair assistance, Refrigerator for Medicines, etc...). &amp;nbsp;If none, please type NONE." name="misc-information-food-allergy-medical-needs-cpap-wheelchair-assistance-refrigerator-for-medicines-etc" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
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