EMGOLD MINING CORPORATION. (the "Issuer")
Request for Financial Statements
National Instrument 51-102 provides shareholders with the opportunity to elect annually to have their name added to the Issuer's supplemental mailing list in order to receive (i) annual financial statements and MD & A and (ii) interim financial statements and MD & A of the Issuer. The documents will be accessible under the Issuer's profile at . However, if you wish to receive any such mailings, please check the applicable box below.
I wish to receive annual financial statements and MD & A ______
I wish to receive interim financial statements and MD & A ______
COMPLETE AND RETURN THIS FORM TO:
EMGOLD MINING CORPORATION
1400 – 570 Granville Street
Vancouver, British Columbia, V6C 3P1
Attention: Shareholder Communications
NAME: ___________________________
ADDRESS: ___________________________
_______________________________
POSTAL CODE:
___________________________
SIGNATURE OF
SHAREHOLDER:
______________________________________DATE:____________
