Registration will be secured only on receipt of full payment.

Please send all communication, registration information and deposit slip information via
e-mail: registration@mushroomacademy.com

Bank account details for direct deposits:
Account name: Cape Connoisseur Champignons (Pty) Ltd
Registration number 1967/010120/07
Trading as the South African Gourmet Mushroom Academy
Bank: Standard Bank
Branch: Stellenbosch
Branch number: 05-06-10
Account number: 073-005-878
Type of account: Current


Please fill in the required information below:


Your prefered course date:
 

Personal Information:
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Title:* Surname:* Initials: First Name:*
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qualification:		 Occupation:  

 
ID or passport no: Date of birth: Special dietary restrictions / Allergies:
 
Address:* City:* Province/State:* Country:*
Telephone (Office):*
(Eg. +27218869880)		 Telephone (Home): Cellular: Fax:
E-mail:* Company: VAT number:  
 
Will make use of the complementary accommodation*: Yes   No
Estimated time of arrival*:    
   
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