<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Traveler Information"/> <field type="paragraph" subtype="p" label="&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;"/> <field type="text" required="true" label="First name" name="first-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="Preferred name (nickname)" name="preferred-name" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Gender" name="gender"> <option label="F" value="female">F</option> <option label="M" value="male">M</option> <option label="X" value="other">X</option> </field> <field type="date" required="true" label="Birthday (these tours are for adults aged 18+)" name="birthday" className="form-control"/> <field type="paragraph" subtype="p" label="&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;"/> <field type="text" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Primary phone number" name="phone-number" 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="paragraph" subtype="p" label="&nbsp; &nbsp; &nbsp; &nbsp;&nbsp;"/> <field type="header" subtype="h2" label="Passport Information"/> <field type="checkbox-group" required="true" label="I understand that I must have a passport book valid 6 months beyond the return date of this trip and it has at least 2 blank pages." name="i-understand-that-i-must-have-a-passport-book-valid-6-months-beyond-the-return-date-of-this-trip-and-it-has-at-least-2-blank-pages"> <option label="I understand" value="i-understand">I understand</option> </field> <field type="checkbox-group" required="true" label="I understand that the purchase of travel insurance is a requirement of booking this tour and that a quote will be provided upon deposit. I understand that this purchase is time sensitive and will protect my investment. I agree to provide Bliss Trips etc, LLC with the policy confirmation and proof of purchase if I purchase travel insurance on my own." name="i-understand-that-the-purchase-of-travel-insurance-is-a-requirement-of-booking-this-tour-and-that-a-quote-will-be-provided-upon-deposit-i-understand-that-this-purchase-is-time-sensitive-and-will-protect-my-investment-i-agree-to-provide-bliss-trips-etc-llc-with-the-policy-confirmation-and-proof-of-purchase-if-i-purchase-travel-insurance-on-my-own"> <option label="I agree and understand the terms of booking this tour" value="i-agree-and-understand-the-terms-of-booking-this-tour">I agree and understand the terms of booking this tour</option> </field> <field type="paragraph" subtype="p" label="&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;"/> <field type="checkbox-group" required="true" label="Holding group space in Europe is time sensitive. Are you able to put down a $750 per person, non-refundable deposit for this trip once this group is filled? (a minimum of 10 people are required for each tour type to be considered filled)" name="holding-group-space-in-europe-is-time-sensitive-are-you-able-to-put-down-a-nonrefundable-deposit-for-this-trip-by-june-27-2024"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="radio-group" required="true" label="I am Reserving My Spot for the following tour:" name="i-am-reserving-my-spot-for-the-following-tour"> <option label="Italian BLISS (the FULL 12-Day Tour) Aug 27-Sept 7, 2025" value="italian-bliss-the-full-12day-tour-aug-27sept-7-2025">Italian BLISS (the FULL 12-Day Tour) Aug 27-Sept 7, 2025</option> <option label="Italian KISS (Rome/Orvieto/Florence) Aug 27-Sept 3, 2025" value="italian-kiss-romeorvietoflorence-aug-27sept-3-2025">Italian KISS (Rome/Orvieto/Florence) Aug 27-Sept 3, 2025</option> <option label="Italian LA DOLCE VITA (Florence/Naples/Sorrento) Aug 30-Sept 7, 2025" value="italian-la-dolce-vita-florencenaplessorrento-aug-30sept-7-2025">Italian LA DOLCE VITA (Florence/Naples/Sorrento) Aug 30-Sept 7, 2025</option> </field> <field type="paragraph" subtype="p" label="&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;"/> <field type="paragraph" subtype="p" label="NOTE:&nbsp; In Europe, it is the norm to have 2 twin beds per room. Those beds can or will be pushed together for couples or will be arranged separate for individuals rooming together."/> <field type="paragraph" subtype="p" label="&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;"/> <field type="radio-group" required="true" label="Which Room Type you are reserving?" description="Double Occupancy Room -or- Single Occupancy Room" name="which-room-type-you-are-reserving"> <option label="Double/Twins (I have a roommate)" value="doubletwins-i-have-a-roommate">Double/Twins (I have a roommate)</option> <option label="Single Occupancy" value="single-occupancy">Single Occupancy</option> <option label="Double/Twins - I need a roommate!" value="doubletwins-i-need-a-roommate">Double/Twins - I need a roommate!</option> </field> <field type="text" label="If you chose Double/Twins room type, please enter your roommate's first and last name (if known at this time):" name="if-you-chose-doubletwins-room-type-please-enter-your-roommates-first-and-last-name-if-known-at-this-time" subtype="text" className="form-control"/> <field type="text" required="true" label="How did you hear about our escorted group trip?" name="how-did-you-hear-about-our-escorted-group-trip" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="I have agreed to submitting this form and understand that Bliss Trips etc, LLC will be contacting me via email, phone and/or text message to complete my reservation and communicate with me." inline="true" name="i-have-agreed-to-submitting-this-form-and-understand-that-bliss-trips-etc-llc-will-be-contacting-me-via-email-phone-andor-text-message-to-complete-my-reservation-and-communicate-with-me"> <option label="I agree" value="i-agree">I agree</option> <option label="I don't agree" value="i-dont-agree">I don't agree</option> </field> <field type="paragraph" subtype="p" label="&nbsp; &nbsp; &nbsp; &nbsp;&nbsp;"/> <field type="paragraph" subtype="p" label="Thank you for your inquiry.&nbsp; We will be in touch within 48 business hours. Please look for any emails coming from janet@blisstripsetc.com. Adding this email address to your contacts will prevent our emails going to your junk or spam folders."/> </fields> </form-template> </body> </html>
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