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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.

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?
11 - Inside double stateroom $2,189
10 - Inside double stateroom $2,199
9 - Inside double stateroom $2,219
8 - Ocean-view double stateroom with window $2,519
7 - Ocean-view double stateroom with window $2,619
2d - Deluxe ocean-view double stateroom with veranda (obstructed view) $2,619
2c - Deluxe ocean-view double stateroom with veranda (partially obstructed) $2,649
2b - Deluxe ocean-view double stateroom with veranda $2,739
2a - Deluxe ocean-view double stateroom with veranda $2,889
1c - Deluxe ocean-view double stateroom with veranda $2,769
1b - Deluxe ocean-view double stateroom with veranda $2,849
1a - Deluxe ocean-view double stateroom with veranda $2,919
SV - Sunset Veranda stateroom $2,999
C3 - Concierge Class double stateroom with veranda $2,869
C2 - Concierge Class double stateroom with veranda $3,419
C1 - Concierge Class double stateroom with veranda $3,569
A2 - Aqua Class stateroom with veranda $3,469
A1 - Aqua Class stateroom with veranda $3,619
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