Micromem (MMTIF) 6-K Notice of Annual Meeting of Shareholders

Exhibit 99.3

MICROMEM TECHNOLOGIES INC.
777 Bay Street, Suite 1910, Toronto, Ontario M5G 2E4

2010 Request for Interim and /or Annual Financial Statements

In accordance with National Instrument 51-102 –Continuous Disclosure Obligations,shareholders may elect annually to have their names added to the issuer’s Supplemental Mailing List for Financial Statements with MD&A.

Please indicate your choices below and return to:

Equity Transfer & Trust Company
200 University Avenue, 4^thFloor
Toronto, ON M5H 4H1

I HEREBY CERTIFY that I am a Shareholder of the Company, and as such, request that you provide me with the following:

[  ] Interim Financial Statements with MD&A

[  ] Annual Financial Statements with MD&A

PLEASE PRINT

FIRST NAME LAST NAME

ADDRESS

CITY PROVINCE/ STATE POSTAL / ZIP CODE

COUNTRY

SIGNED:
	(Signature of Shareholder)

THIS IS AN ADDRESS CHANGE [  ]