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South America Carnival in Rio cruise Share Request

Please put me on the roommate share list for PIED PIPER's South America Carnival in Rio cruise Cruise. Fields marked with* are Required.

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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:
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Which categories would you like to be listed for?
IR1 - Deluxe interior stateroom $799
IR2 - Deluxe interior stateroom $809
OO - Junior Oceanview stateroom (obstructed view) $959
OR1 - Deluxe Oceanview stateroom $1,029
BP - Deluxe Balcony stateroom (partial view) $1,159
BR1 - Deluxe Balcony stateroom $1,249
BR2 - Deluxe Balcony stateroom $1,259
BL1 - Premium Balcony stateroom $1,309
BL2 - Premium Balcony stateroom $1,319
BA - Balcony Aurea stateroom $1,469
SL1 - Premium Suite Aurea $2,139
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