Enrollment Form

Yes! Please enroll me as a new member.

First and Last Name:
Spouse/Partner's Name:
Address Line 1:
Address Line 2:
City:
Postal Code:
Home Phone:
Business Phone:
E-mail Address:
VISA number (if applicable):
Expiry Date:
Name as on Card:

Please check the membership you would like to purchase:

April 1 - Sept 30 (Full Rate)

Single ($27.00)      Couple ($42.00)

Oct 1 - Jan 31 - Half price)

Single ($13.50)     Couple ($21.00)

Feb 1 - March 31 - Full rate includes remainder of current year plus next year)

Single ($27.00)      Couple ($42.00)

(All NEW memberships are assessed a one-time $25.00 cellar stocking fee.)

VISA Credit Card payment may be choosen for payment of Membership fees. Otherwise a cheque payable to "The South African Wine Society" is required. If VISA payment is elected, event registration and subsequent membership renewal can be handled securely by phone or by return email. All charges will appear on their VISA statements under Pushka Holdings.

We look forward to welcoming you as a member of the South Africian Wine Society.

For more information about the South African Wine Society in Canada, please contact us at 905-762-9161 or email us at SAWSinfo@rogers.com.