1. Name, address and telephone number of the issuer of the security.
   
   ____________________________________________________
   
   Name of issuer
   
   ____________________________________________________
   
   Address
   
   (_____)______________________________________________
   
   Telephone number
   
   
2. Name, address and telephone number of the selling control person.
   
   _____________________________________________________
   
   Name of control person
   
   _____________________________________________________
   
   Address
   
   (_____)______________________________________________
   
   Telephone number
   
   
3. State whether the control person is a director or officer of the issuer (if an officer, state title).
   
   _____________________________________________________
   
   
4. Describe the type of security of the issuer and the number beneficially owned, directly or indirectly, by the control person.

__________________________________

Name of control person (please print)

__________________________________

Signature of control person or, if the
control person is a company, signature of
authorized signatory

__________________________________

Name and office of authorized signatory

(please print)

1. If the space provided for any answer is insufficient, additional sheets may be used. Each additional sheet must be cross referenced to the relevant section of the Form 23 and signed by the person who signs the form.
   
   
2. An initial Form 23 must be filed with the British Columbia Securities Commission and with each exchange in Canada on which the securities proposed to be sold are listed, at least 7 days before the initial sale of the securities.
   
   
3. An initial Form 23 and any renewal Form 23 must be signed by the control person not more than 24 hours before it is filed.
   
   
4. If the control person is selling securities in reliance on an exemption under section 74(2) of the Act, or section 128(d) of the Rules, or under an order issued under section 76 of the Act, the control person must file an insider report in the required form on or before the 3rd day after the distribution of the securities. The required form is Form 36.
   
   
5. An initial Form 23 is valid for a maximum of 60 days. If the control person intends to continue selling the securities beyond the 60 day period, a renewal Form 23 must be filed with the Commission and the exchanges before the end of the 60 day period. A renewal Form 23 is valid for a maximum of 28 days and must be continually renewed before the end of each 28 day period as long as the control person intends to continue selling the securities.
   
   
6. If the control person has sold all the securities proposed to be sold in the initial Form 23, or if any of those securities are no longer for sale, the control person must file a Form 23 with the Commission and the exchanges stating the number of securities that have been sold, or are no longer for sale. The form must be filed before the end of the 60 day period if the control person has only filed an initial Form 23, or before the end of the 28 day period if a renewal Form 23 has been filed.
   
   
7. An initial Form 23 and any renewal Form 23 filed with the Commission must be accompanied by a completed Fee Checklist and the required fee. In order to determine the fee payable, consult item 31 of section 22 of the Securities Regulation, R.B.C. Reg. 196/97. Cheques should be made payable to the "British Columbia Securities Commission".
   
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   Freedom of Information and Protection of Privacy Act: The personal information requested on this form is collected under the authority of and used for the purpose of administering the Securities Act. Questions about the collection or use of this information can be directed to the Supervisor, Insider Reporting (604-899-6548), 200 - 865 Hornby Street, Vancouver, British Columbia V6Z 2H4. Toll Free in British Columbia 1-800-373-6393.
   
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