Cape Wine Master Application Form

CAPE WINE MASTER APPLICATION FORM
SECTION A

PERSONAL DETAILS
Title*
Full Name*

First Name (s)Surname
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Number
Please enter a valid phone number.
Cell Number*
Please enter a valid phone number.
Email Address*
example@example.com
Nationality*
ID Number (Passport number if not SA National)*

SECTION B

QUALIFICATIONS
Cape Wine Academy Qualification

Please fill in the marks (in percentage format) obtained for each module below
Diploma, Module 1: Mark obtained
Diploma, Module 2: Mark obtained
Diploma, Module 3: Mark obtained
Diploma, Module 4: Mark obtained
Diploma, Tasting: Mark obtained
Graduation date

YearMonthDay
Date
Exam Venue

StellenboschJohannesburgOther (specify)
Other Wine Qualifications or Education

Please load a copy of your certificate(s) to verify your qualification details and results
File Upload

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1. University / Academy / Institution Name
Highest level achieved
Marks achieved
Graduation date

YearMonthDay
Date
2. University / Academy / Institution Name
Highest level achieved
Marks achieved
Graduation date

YearMonthDay
Date
COST OF CWM PROGRAM: R 36 000.00 (including 15% VAT)

Payable as follows:
- R 10 000 on acceptance into the programme
- 4 x R2000 per tasting exam payable on registration in October/November
- 4 x R1250 per theory exam payable on registration in October/November
- 1 x R3500 CWM Seminar payable on registration in July
- 1 x R3500 Practical Tasting presentation exam payable on presentation of topics year 2+
- 1 x R4500 Research Project fees payable on submission of first draft in November year 2+
- 1 x Graduation Fees payable in August in the year of your graduation.
Note: Fees are NOT payable in full or in advance and only become due on entry into the 10 examination areas or at the time of participation in the various seminar/s, presentation, submission of your Research Project or before your graduation.

SECTION C

Payment can be made via EFT or by Credit Card. Please use your name and CWM registration number as a reference. Payment advice must be emailed to info@capewineacademy.co.za
Please select a payment option below*

EFTCredit CardInvoice
EFT | CAPE WINE ACADEMY BANKING DETAILS

Account Name: Cape Wine Academy NPC

Bank: FNB

Account Type: Enterprise Business Account

Branch Code: 210655

Account Nr: 62902983338
CREDIT CARD | ONLINE PAYMENT

Credit Card payment of your registration fee may be made here
INVOICE REQUEST

If you wish us to invoice your employer, please complete the details below.
Entity Name*
Entity Registration number*
Entity VAT number (if applicable)*
Entity Contact Person*
Entity Contact Number
Please enter a valid phone number.
Entity Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

CAPE WINE MASTER APPLICATION FORM

SECTION A

SECTION B

Cape Wine Academy Qualification

Other Wine Qualifications or Education

SECTION C