1. the purchaser is to complete all the information in the boxes on page 1 and sign where indicated with an “ x ”. 2. if the purchaser is a canadian resident and is an accredited investor, then complete the “ accredited investor questionnaire ” that starts on page 5. 3. if the purchaser is a canadian resident and is not an accredited investor, and not purchasing a minimum of $ 150, 000 in value of securities, complete the “ friends and family ” questionnaire that starts on page 8. 4. residents of countries outside the united states and canada and canadian residents purchasing a minimum of $ 150, 000 in value of securities may subscribe without filling in an accredited investor or friends and family questionnaire. 5. all other information must be filled in where appropriate. 6. confirm with the company that funds are in transit – please send via facsimile transmission, a copy of your wire transfer instructions to your banking institution immediately upon those instructions being issued by you. facsimile number # # # - # # # - # # # # attention : harvey lalach, president ( tel : 250 # # # - # # # - # # # # ) email – * * * @ * * * wire instructions : hsbc bank canada885 west georgia street vancouver, british columbia v6c 3g1 canadaaccount : swift code : us account no : _ _ _ _ _ _ _ _ _ _ units us $ 1. 25 per unit for a total purchase price of us $ the purchaser owns, directly or indirectly, the following securities of the issuer : [ check if applicable ] the purchaser is [ ] an insider of the issuer or [ ] a member of the professional group _ _ _ _ _ _ _ _ _ _ units us $ 1. 25 per unit for a total purchase price of us $ the purchaser owns, directly or indirectly, the following securities of the issuer : [ check if applicable ] the purchaser is [ ] an insider of the issuer or [ ] a member of the professional group registration instructions delivery instructions name to appear on certificate name and account reference, if applicable account reference if applicable contact name address address telephone number registration instructions delivery instructions name to appear on certificate name and account reference, if applicable account reference if applicable contact name address address telephone number witness : execution by purchaser : x signature of witness signature of individual ( if purchaser is an individual ) x name of