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South America, Patagonia and Argentina cruise Share Request

Please put me on the roommate share list for PIED PIPER's South America, Patagonia and Argentina cruise Cruise. Fields marked with* are Required.

Email Address*

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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?
Z - Inside stateroom guaranty $999
12 - Inside stateroom $1,281
11 - Inside stateroom $1,281
Y - Ocean-view stateroom guaranty $1,199
O2 - Oceanview stateroom $1,828
V3 - Veranda (partial view) stateroom $1,867
V2 - Veranda stateroom $1,916
V1 - Prime Veranda stateroom $1,956
DV - Deluxe Veranda stateroom $2,122
XC - Concierge Class veranda stateroom guaranty $1,699
C2 - Concierge Class veranda stateroom $2,328
C1 - Prime Concierge Class veranda stateroom $2,417
XA - Aqua Class stateroom with veranda guaranty $3,089
A1 - Prime Aqua Class stateroom with veranda $3,303
A2 - Aqua Class stateroom with veranda $3,214
W - Sky Suite with veranda guaranty $5,650
AS - Aqua Class Sky Suite $7,254
CS - Celebrity Suite with veranda $9,141
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