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Transatlantic cruise to Greenland/Iceland Reservation Form


August 6–18, 2023

PASSENGER INFORMATION
FIRST PASSENGER INFORMATION
E-mail *

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First Name *
Middle Name
Last Name *
Gender * Male Female
Reservation number for existing reservations
Address *
Address 2
City *
State/Province * Choose 'N/A' for non-US/Canadian passengers
Postal / ZIP Code *
Country *
Number
Home Phone *
Cell Phone
Work Phone
Date of Birth *
I want my travel agent to handle this booking. (PIED PIPER pays commissions to certified travel agents for its gay group cruises!) No Yes
Travel Agent Name
Travel Agent Email
Travel Agent Tel
Travel Agent Fax
Travel Agent Address
SECOND PASSENGER INFORMATION
(Leave blank if traveling alone, you may indicate below if you would like to arrange a share.)
E-mail *
First Name *
Middle Name
Last Name *
Gender * Male Female
Address*
Address 2
City *
State/Province * Choose 'N/A' for non-US/Canadian passengers
Postal / ZIP Code *
Country *
Number
Home Phone *
Cell Phone
Work Phone
Date of Birth *
CRUISE INFORMATION
I wish to sail on the Transatlantic cruise to Greenland/Iceland - August 6–18, 2023
CABIN INFORMATION
I would like a cabin in the Category & per-person price selected: *
If not available, my second choice Category & per person price is:
Arrange Share No Yes
For shares, are you a Smoker? No Yes
DINING REQUEST

Late seating is suggested so that you may dine with other group members. As most of the group will be dining in the late sitting, if you request early dining we will most likely not be able to put you at a group dining table. Also, our group cocktail parties and other events are timed to coincide with the late dining sitting.

I would like to request*   Early Dinner Sitting Late Dinner Sitting
Table size* Small (2) Large (8-12)
Please seat us with the following passengers:
One name per line, please
Please tell us if we should know anything about you including dietary needs, etc.
TRAVEL INSURANCE *
Yes, please contact me with information regarding travel insurance
No, I will not be requiring travel insurance.
PAYMENT INFORMATION *
I am paying by check (If paying by check, we must receive your payment by mail within 5 business days of submitting your form. Please make all checks payable to PIED PIPER TRAVEL.)
My credit card will be billed $450.00 per person immediately to secure my reservation. Final Payment Due as per Payment Schedule, below. (E-mail will be sent with confirmation.)
Credit Card Number: *
Expiration Date: *
I am authorizing Pied Piper Travel, the cruise line and the cruise operator to automatically charge deposits, service fees, payments, insurance (if applicable), flight payments (if applicable) and cancellation fees to my credit card in accordance with the payment schedule and cancellation policy.
Card Holder's Name: *
ADDITIONAL CREDIT CARD
If an additional credit card is supplied then all charges will be split evenly, unless alternate payment instructions are provided in the comments section of this form.
Credit Card Number: *
Expiration Date:
I am authorizing Pied Piper Travel, the cruise line and the cruise operator to automatically charge deposits, service fees, payments, insurance (if applicable), flight payments (if applicable) and cancellation fees to my credit card in accordance with the payment schedule and cancellation policy.
Card Holder's Name:
DEPOSITS, FINAL PAYMENT AND CANCELLATION SCHEDULE PER PERSON
Deposit Due at time of booking (No refunds plus cancellation fee of $75pp) / Final Payment Due 90 days prior to sailing (Cancellation Fee 50%) / No Refunds 60 days prior to sailing.
OTHER INFORMATION AND CONDITIONS

Liability and Responsibility - Please read the following carefully. Making a reservation and acceptance of tickets and/or vouchers shall be deemed to be an acceptance of these conditions. PIED PIPER TRAVEL, the tour operator, acts solely as an agent for the passenger. PIED PIPER TRAVEL and does not accept responsibility in whole or part for any delay, loss, accidents, personal injury, sickness, medical expenses, or property damage occasioned by fault or negligence of any person, employee or company entrusted with the performance of such service from whatever cause. The tour operator and cruise line will not be responsible for any expense or inconvenience caused by late arrivals and departures of trains, ships, airplanes, buses, autos or any changes of schedule beyond its control. The tour operator and cruise line will not accept responsibility for the loss of, or damage to your luggage, money, jewelry, valuables or any other belongings whatsoever and howsoever caused.

The tour operator is responsible for all services to be provided in respect to this tour. All tour services, including but not limited to hotel accommodations, restaurants, guide services, ground transportation, and cruise transportations, are furnished by contractors that are independent from, and that do not act for or on behalf of or as agents of or as joint ventures with the air carrier, cruise line or tour operator.

The right is reserved by the tour operator to make any changes that might become necessary with or without notice. The tour operator reserves the right to accept or decline any person as a member of the tour at any time and to cancel the tour if minimum space requirements are not met. The passenger agrees to the use of his/her likeness in photo or video, unless specifically specified otherwise in writing.

The sole and exclusive responsibility of the air carrier and cruise lines shall be in accordance with and as limited by the contract of carriage set forth in the passenger's ticket, baggage check and tariffs issued by the carrier/cruise line. The cruise line ticket and contract will be included in passenger documents. The passenger ticket, when used, shall constitute a sole contract between the airlines/cruise lines and the purchaser of these tickets and/or passenger. These carriers and other carriers are not responsible for any act, omission or event during the time the passengers are not on board their planes or conveyances.

Deposit/Cancellation Policy Per Person - Any changes in passenger name will be considered a cancellation. All deposits, payments, and cancellation fees are per person. The purchase of trip cancellation insurance to protect the passenger is strongly recommended and can be arranged by your travel agent.

AIRLINE FLIGHT RESERVATIONS *
Arrange my flights? * No, I will arrange my own flights. (If checked, ignore rest of Airline Flight section)
Yes please send me a quote for airfare: (Leave blank if not applicable) 
Class: Economy Class  Business Class  First Class
Gateway City: Enter Departure Airport City or Code
Departure Date: Departure Time:
Return Date: Return Time:
OTHER SERVICES AND RESERVATIONS
Please tell us if you need hotel reservations, car rental, transfer, etc.
TERMS AND CONDITIONS
I agree to the tour operator (Pied Piper Travel) Terms and Conditions *
ELECTRONIC SIGNATURE / AUTHORIZATION *
I verify that I am at least 21 years of age. I have read the above terms and conditions and acknowledge I have been offered travel insurance.
Passenger 1 * Date *
Passenger 2 * Date *
EXTRA INFORMATION
Where did you hear about us?
Comments Box
NOTE: Your reservation isn't confirmed until we have provided you with a booking number by phone or e-mail.
Please print this completed form for your records before hitting the submit button.