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Chile, Peru, and Machu Picchu cruise Share Request

Please put me on the roommate share list for PIED PIPER's Chile, Peru, and Machu Picchu 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?
12 - Inside double stateroom $1,749
10 - Inside double stateroom $1,889
9 - Inside double stateroom $1,959
8 - Ocean-view double stateroom with window $2,099
6 - Ocean-view double stateroom with window $2,169
5 - Deluxe ocean-view double stateroom with window $2,239
V3 - Veranda stateroom $3,779
V2 - Veranda stateroom $3,849
V1 - Veranda stateroom $3,919
P3 - Club Veranda Stateroom $3,989
P2 - Club Veranda Stateroom $4,059
P1 - Club Veranda Stateroom $4,199
N2 - Club Continent suite $5,319
N1 - Club Continent suite $5,389
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