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<div class="wpforms-container wpforms-container-full" id="wpforms-22880"><form id="wpforms-form-22880" class="wpforms-validate wpforms-form" data-formid="22880" method="post" enctype="multipart/form-data" action="/category/palau-dive-adventures/"><noscript class="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</noscript><div class="wpforms-field-container"><div id="wpforms-22880-field_16-container" class="wpforms-field wpforms-field-html form-title" data-field-id="16"><div id="wpforms-22880-field_16"><h2>Send my booking request</h2>
<p>Or just call us <a href="tel:00 1 213 310 321 2558">+1(310) 321-2558</a> U.S.A. reservations</p>
</div></div><div id="wpforms-22880-field_2-container" class="wpforms-field wpforms-field-name" data-field-id="2"><label class="wpforms-field-label" for="wpforms-22880-field_2">Your Full Name <span class="wpforms-required-label">*</span></label><input type="text" id="wpforms-22880-field_2" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][2]" required></div><div id="wpforms-22880-field_4-container" class="wpforms-field wpforms-field-email" data-field-id="4"><label class="wpforms-field-label" for="wpforms-22880-field_4">Your Email address <span class="wpforms-required-label">*</span></label><input type="email" id="wpforms-22880-field_4" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][4]" required></div><div id="wpforms-22880-field_8-container" class="wpforms-field wpforms-field-phone" data-field-id="8"><label class="wpforms-field-label" for="wpforms-22880-field_8">Telephone Number</label><input type="tel" id="wpforms-22880-field_8" class="wpforms-field-medium" name="wpforms[fields][8]" placeholder="+(123)-4567890" ><div class="wpforms-field-description">Please include your country code</div></div><div id="wpforms-22880-field_10-container" class="wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first" data-field-id="10"><label class="wpforms-field-label" for="wpforms-22880-field_10">Arrival date <span class="wpforms-required-label">*</span></label><input type="text" id="wpforms-22880-field_10" class="wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium" data-date-format="m/d/Y" name="wpforms[fields][10][date]" required></div><div id="wpforms-22880-field_11-container" class="wpforms-field wpforms-field-date-time wpforms-one-half" data-field-id="11"><label class="wpforms-field-label" for="wpforms-22880-field_11">Departure date <span class="wpforms-required-label">*</span></label><input type="text" id="wpforms-22880-field_11" class="wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium" data-date-format="m/d/Y" name="wpforms[fields][11][date]" required></div><div id="wpforms-22880-field_14-container" class="wpforms-field wpforms-field-text wpforms-one-half wpforms-first people-up-down" data-field-id="14"><label class="wpforms-field-label" for="wpforms-22880-field_14"># of People</label><input type="text" id="wpforms-22880-field_14" class="wpforms-field-medium" name="wpforms[fields][14]" value="1" ></div><div id="wpforms-22880-field_17-container" class="wpforms-field wpforms-field-text wpforms-one-half people-up-down" data-field-id="17"><label class="wpforms-field-label" for="wpforms-22880-field_17"># of Divers</label><input type="text" id="wpforms-22880-field_17" class="wpforms-field-medium" name="wpforms[fields][17]" value="1" ></div><div id="wpforms-22880-field_20-container" class="wpforms-field wpforms-field-radio" data-field-id="20"><label class="wpforms-field-label" for="wpforms-22880-field_20">Where would you like to stay? <span class="wpforms-required-label">*</span></label><ul id="wpforms-22880-field_20" class="wpforms-field-required"><li class="choice-1 depth-1"><input type="radio" id="wpforms-22880-field_20_1" name="wpforms[fields][20]" value="Palau Royal Resort" required ><label class="wpforms-field-label-inline" for="wpforms-22880-field_20_1">Palau Royal Resort</label></li></ul></div><div id="wpforms-22880-field_18-container" class="wpforms-field wpforms-field-textarea" data-field-id="18"><label class="wpforms-field-label" for="wpforms-22880-field_18">Ask us any questions you have about a dive trip to Palau.</label><textarea id="wpforms-22880-field_18" class="wpforms-field-medium" name="wpforms[fields][18]" ></textarea></div></div><div class="wpforms-field wpforms-field-hp"><label for="wpforms-22880-field-hp" class="wpforms-field-label">Message</label><input type="text" name="wpforms[hp]" id="wpforms-22880-field-hp" class="wpforms-field-medium"></div><div class="wpforms-recaptcha-container" ><div class="g-recaptcha" data-sitekey="6Lf7O6kUAAAAAPPRquZB9ZAubHattU3q_oL8likU" data-size="invisible"></div></div><div class="wpforms-submit-container" ><input type="hidden" name="wpforms[id]" value="22880"><input type="hidden" name="wpforms[author]" value="3"><button type="submit" name="wpforms[submit]" class="wpforms-submit book-btn blue-btn" id="wpforms-submit-22880" value="wpforms-submit" aria-live="assertive" data-alt-text="Sending..." data-submit-text="Send my request">Send my request</button></div></form></div> <!-- .wpforms-container -->
