Address: __________________________________________________________________

  __________________________________________________________________________ 
 

Telephone: (Home)_____________________  (Work)  ____________________________
 

Fax: ________________________________ 
 

E-mail Address:____________________________________________________________
 

Age: ______________________________ 
 

Amount Enclosed: _________________________________________________________
 

Date: ___________________________ Signature: __________________________
 
 

FOR OFFICIAL USE:

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Please return to:
Shanaaz Parker School of Cooking,
P. O. Box 117, Retreat, 7965, South Africa
Fax: +27 21 7011701
E-mail:ashihara@iafrica.com