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Independence Day Celebration Cruise Share Request

Please put me on the roommate share list for PIED PIPER's Independence Day Celebration 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?
IE - Standard inside, lower deck, forward or aft $3,379
IC - Standard inside, lower deck, forward or aft $3,379
IB - Standard inside, lower deck, midship $3,529
HB - Atrium View, inside, lower deck, midships $3,739
EF - Oceanview, lower deck, forward or aft $4,459
DC - Balcony, obstructed view, higher deck, forward or aft $4,879
DB - Balcony, obstructed view, higher deck, midships $4,879
BZ - Sheltered balcony, lower deck, forward $4,999
BY - Sheltered balcony, lower deck, aft $5,179
BV - Sheltered Balcony, midships, forward or aft $5,179
BU - Sheltered balcony, lower deck, midships $5,239
Q2 - Duplex Suite $30,499
Q1 - Grand Deluxe Suite $37,339
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