Share your information with Arlene Hagley

Arlene Hagley

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		<field type="header" subtype="h1" label="Cruise Reservation REQUEST Form&amp;nbsp; for MSC Cruise line.&amp;nbsp; I will call you to review."/>&#13;
		<field type="header" subtype="h1" label="Note: * Travelers must have proper travel documents.* Passport BOOKS are PREFERRED for travel, but an ORIGINAL Certified Birth Certificate with a Gov&#39;t ID can be used by US Citizens. Travelers must use their legal names as it appears on the document, as changes/corrections will incur a fee."/>&#13;
		<field type="text" required="true" label="First name" description="Must be as on your travel documents" 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" description="Must be as on your travel documents" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Full name as it appears on Passport or US birth certificate" description="Must be EXACTLY as shown" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Important: Every traveler 18 years of age and older will need a REAL ID-compliant driver’s license or identification card, state-issued enhanced driver’s license, or another TSA-acceptable form of identification at airport security checkpoints for international, domestic air travel or cruising without a passport."/>&#13;
		<field type="text" required="true" label="Email" description="Best email or NA for children" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Cell phone number - no landline" description="Best contact or N/A for children" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="I want to book:" description="Can be changed" name="i-want-to-book" other="true">&#13;
			<option label="MSC World America  November 21 - 28, 2026" value="msc-world-america-november-21-28-2026">MSC World America  November 21 - 28, 2026</option>&#13;
			<option label="Not sure which MSC cruise and date" value="not-sure-which-msc-cruise-and-date">Not sure which MSC cruise and date</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Do you have any mobility need that require an &quot;accessible&quot; cabin or need a specific area of the ship? Please be specific and let&#39;s chat." description="N/A if none. Requests are based on availability at that time ." name="do-you-have-any-mobility-need-that-require-an-accessible-cabin-or-need-a-specific-area-of-the-ship-please-be-specific-and-lets-chat" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Emergency Contact" description="First &amp;amp; Last Name" placeholder="Full Name" name="emergency-contact" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Emergency Contact&#39;s Phone Number" description="Best Contact Number" placeholder="Best Contact Number" name="emergency-contacts-phone-number" subtype="text" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="*If a family is sharing a cabin, register yourself,&amp;amp;nbsp; AND add names and DoB below.&amp;amp;nbsp; If a quad or triple is needed or connecting cabins, I will send you a quote to approve.&amp;amp;nbsp; It is your responsibility to ensure that payments are made on time and as agreed *"/>&#13;
		<field type="text" required="true" label="Rooming with&amp;nbsp; #1 (Full Name and Date of Birth) or N/A" description="Name and DoB of Cabin mate  if  registering yourself and family or friend for this cabin." name="rooming-with" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Rooming with #2 (Full Name and Date of Birth)" name="rooming-with-2-full-name-and-date-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Rooming with #3 (Full Name and Date of Birth)" name="rooming-with-3-full-name-and-date-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Bed Configuration" description="Separate or together?? Need a pullout? Bunk-beds?" name="bed-configuration" other="true">&#13;
			<option label="Beds Separate" value="beds-separate">Beds Separate</option>&#13;
			<option label="Beds Together" value="beds-together">Beds Together</option>&#13;
		</field>&#13;
		<field type="textarea" label="Any milestone celebrations while on the cruise?&amp;nbsp; Be specific with whom and the date!" description="N/A if none." name="any-milestone-celebrations-while-on-the-cruise-do-you-need-my-help-to-book-a-boom-or-event-space" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Important: You will see CC charges by MSC Cruise Line based on your trip payment options of&amp;nbsp; cabin deposit and extras,&amp;nbsp; plus payments to complete balance owed. You will approve the invoice BEFORE any payment is due or paid. You will authorize the invoice then payment is made to MSC Cruise Line."/>&#13;
		<field type="radio-group" required="true" label="Travel Insurance - Highly recommended but optional and your choice." description="Trip payments are non-refundable. You are strongly advised to purchase travel insurance in case of unforeseen cancellations or trip interruptions." name="radio-group-1543720603529">&#13;
			<option label="Yes, I want the MSC Cruise only Insurance - please add" value="yes-i-want-the-msc-cruise-only-insurance-please-add">Yes, I want the MSC Cruise only Insurance - please add</option>&#13;
			<option label="No, please send me a link to quote other options" value="no-please-send-me-a-link-to-quote-other-options">No, please send me a link to quote other options</option>&#13;
			<option label="No thank you, I will get my own travel insurance" value="no-thank-you-i-will-get-my-own-travel-insurance">No thank you, I will get my own travel insurance</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Gratuity" description="Gratuity can be paid prior to sailing or on board." name="gratuity">&#13;
			<option label="Yes, I want to pre-pay my gratuity - Additional $$" value="yes-i-want-to-prepay-my-gratuity-additional-">Yes, I want to pre-pay my gratuity - Additional $$</option>&#13;
			<option label="No, I'll pay on the ship" value="no-ill-pay-on-the-ship">No, I'll pay on the ship</option>&#13;
		</field>&#13;
		<field type="text" label="MSC Loyalty Number, if any?" description="Are you a cruiseline rewards member?" name="cruise-line-rewards-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Verification of traveler information and Email marketing" name="verification-of-traveler-information">&#13;
			<option label="By checking this box, I agree that the traveler information I have provided on this form, matches the Traveler's ID and that the ID is valid for the dates of travel.  I accept responsibility for any fees for changes or corrections. Also, for any email marketing, I understand that I can unsubscribe at any time." value="by-checking-this-box-i-agree-that-the-traveler-information-i-have-provided-on-this-form-matches-the-travelers-id-and-that-the-id-is-valid-for-the-dates-of-travel-i-accept-responsibility-for-any-fees-for-changes-or-corrections-also-for-any-email-marketing-i-understand-that-i-can-unsubscribe-at-any-time">By checking this box, I agree that the traveler information I have provided on this form, matches the Traveler's ID and that the ID is valid for the dates of travel.  I accept responsibility for any fees for changes or corrections. Also, for any email marketing, I understand that I can unsubscribe at any time.</option>&#13;
		</field>&#13;
	</fields>&#13;
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