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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?
IB - Interior stateroom $1,109
IE - Interior stateroom $1,033
ID - Interior stateroom $1,018
IA - Interior stateroom $1,215
IC - Interior stateroom $1,054
OZ - Oceanview - Obstructed View $1,149
OY - Oceanview - Obstructed View $1,280
IF - Interior stateroom $999
OE - Oceanview, aft $1,635
OF - Oceanview stateroom $1,549
OW - Oceanview - Obstructed View $1,370
OC - Oceanview stateroom $1,779
OB - Oceanview, midships $1,957
BF - Balcony, forward $1,999
BE - Balcony, forward or aft $2,081
BD - Balcony stateroom $2,115
BB - Balcony stateroom $2,291
BC - Balcony stateroom $2,202
BA - Balcony stateroom $2,433
B4 - Premium Balcony stateroom $2,559
B2 - Premium Balcony stateroom $2,559
ME - Mini suite $2,499
MB - Mini suite $3,055
B1 - Premium Balcony stateroom $2,690
MD - Mini suite $2,739
S6 - Vista suite $4,898
S8 - Family Suite $2,798
M1 - Reserve Collection mini suite $3,249
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