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Panama Canal cruise Share Request

Please put me on the roommate share list for PIED PIPER's Panama Canal cruise Cruise. Fields marked with* are Required.

Email Address*

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Confirm Address*
First Name*
Last Name*
Gender * Male Female
Address*
Address 2
City*
State/Province* Choose 'N/A' for non-US/Canadian addresses
Zip/Postal Code*
Country*
Home Phone #*
Cell Phone #
Work Phone #
Can we leave a message?YesNo
Please tell us how you heard of us:*
(Which magazine/publication?, Which webpage?, From a friend/previous passenger? etc.
Do you currently have a favorite travel agent? (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:
Which categories would you like to be listed for?
12 - Inside double stateroom $2,993
11 - Inside double stateroom $3,024
10 - Inside double stateroom $3,056
9 - Inside double stateroom $3,066
8 - Ocean-view double stateroom with window $3,603
7 - Ocean-view double stateroom with window $3,624
6 - Ocean-view double stateroom with window $3,666
5 - Deluxe ocean-view double stateroom with window $3,718
4 - Deluxe ocean-view double stateroom with window $3,750
2c - Deluxe ocean-view double stateroom with veranda (partially obstructed) $5,515
C3 - Concierge Class double stateroom with veranda $5,975
C2 - Concierge Class double stateroom with veranda $6,090
C1 - Concierge Class double stateroom with veranda $6,310
A2 - Aqua Class stateroom with veranda $6,190
S2 - Sky Suite with floor-to-ceiling windows and veranda $10,599
S1 - Sky Suite with floor-to-ceiling windows and veranda $11,099
Would you like a smoker or non-smoker as a roommate?
Non-smoker Smoker
 
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Thank you for your interest in our cruises! We will call you as soon as we find a roommate for you to make sure you're still interested. Hope to see you onboard!
PLEASE NOTE THAT ALL PAYMENTS MADE FOR SHARE RESERVATIONS ARE NON-REFUNDABLE UNLESS A SHARE REPLACEMENT CAN BE FOUND