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Repositioning cruise from New York to the Caribbean Share Request

Please put me on the roommate share list for PIED PIPER's Repositioning cruise from New York to the Caribbean 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:
Travel Agent Address:
Which categories would you like to be listed for?
Z - Inside double stateroom guaranty * $1,451
12 - Inside double stateroom $1,549
11 - Inside double stateroom $1,581
10 - Inside double stateroom $1,603
9 - Inside double stateroom $1,603
Y - Ocean-view double stateroom with window guaranty $1,729
8 - Ocean-view double stateroom with window $1,827
7 - Ocean-view double stateroom with window $1,869
X - Deluxe ocean-view double stateroom with veranda guaranty $2,567
P2 - Deluxe Porthole view w/Veranda stateroom $2,655
P1 - Deluxe Porthole view w/Veranda stateroom $2,730
EX - Edge stateroom w/ Infinite Veranda guaranty $2,643
E4 - Edge stateroom w/ Infinite Veranda $2,660
E3 - Edge stateroom w/ Infinite Veranda $2,700
E2 - Edge stateroom w/ Infinite Veranda $2,773
E1 - Edge stateroom w/ Infinite Veranda $2,861
XC - Concierge Class guaranty $3,066
C3 - Concierge Class double stateroom with veranda $3,164
C2 - Concierge Class double stateroom with veranda $3,334
C1 - Concierge Class double stateroom with veranda $3,504
XA - Aqua Class stateroom with veranda guaranty $4,403
A2 - Aqua Class stateroom with veranda $4,501
S2 - Sky Suite with floor-to-ceiling windows and veranda $9,033
AS - Aqua Class Suite $9,318
CS - Celebrity Suite with floor-to-ceiling windows $11,230
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