TravelJoy

John Rogers

John Rogers, Travelmation LLC, ITC

2024 Mastermind At Sea - 7279874

Feb 3, 2024 to Feb 11, 2024

Fort Lauderdale, Bahamas, Aruba, Curacao

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Mastermind at Sea Interest (February 3-11)"/>&#13;
		<field type="select" required="true" label="What stateroom are you interested in?" description="Group Rate Staterooms are limited in quantity and must be fully deposited no later than October 4  2023 and paid in full by November 3  2023." name="what-stateroom-are-you-interested-in" className="form-control">&#13;
			<option label="Inside/Interior Stateroom" value="insideinterior-stateroom">Inside/Interior Stateroom</option>&#13;
			<option label="Oceanview (porthole or window) stateroom" value="oceanview-porthole-or-window-stateroom">Oceanview (porthole or window) stateroom</option>&#13;
			<option label="Oceanview with balcony" value="oceanview-with-balcony">Oceanview with balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" required="true" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#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="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" label="Country" name="address-country" 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="text" required="true" label="Are you rooming with someone? If so who?" name="are-you-rooming-with-someone-if-so-who" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Passport Information"/>&#13;
		<field type="paragraph" subtype="p" label="{If you do not have your full passport information at this time, that is ok. At a minimum, please provide your full legal name as it will show on your passport at the time of travel and your date of birth.}"/>&#13;
		<field type="text" required="true" label="Full name as it appears on passport" description="All names must match exactly as they appear on your passport at time of travel." name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration (Passports must be valid more than six months following your return from travel)" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="radio-group" 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" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>