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Cruise to Bermuda Share Request

Please put me on the roommate share list for PIED PIPER's to Bermuda 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?
T1 - Single Studio Stateroom $1,959
IX - Guarantee Inside stateroom $1,459
IT - Solo Inside Stateroom $2,659
IF - Inside stateroom $1,509
IB - Inside stateroom $1,529
IA - Inside stateroom $1,559
OX - Guarantee Oceanview stateroom $1,599
OT - Solo Oceanview Stateroom $2,899
OB - Oceanview stateroom with round window $1,629
OA - Large Oceanview Stateroom $1,689
BX - Guarantee Balcony stateroom $1,899
BT - Solo Balcony Stateroom $3,489
BF - Balcony stateroom $1,929
BB - Balcony stateroom $1,949
BA - Balcony stateroom $1,979
MX - Guarantee Club Balcony Suite $2,579
MB - Forward Facing Club Balcony Suite $2,609
M2 - Forward Facing Club Large Balcony Suite $3,109
SL - Forward Facing Large Balcony Suite $3,009
SK - Forward Facing Large Balcony Suite $3,159
SI - Aft Facing Large Balcony Suite $3,859
HE - Haven Penthouse Balcony Suite $4,889
HB - Haven Penthouse Aft Facing Balcony Suite $6,059
H5 - Haven Penthouse Large Balcony Owner's Suite $6,309
H4 - Haven Aft Facing Large Balcony Owner's Suite $8,009
H3 - Haven Large Balcony Deluxe Owner's Suite $11,509
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