PLEASE FILL OUT THE FOLLOWING FORM:
ALL INFORMATION IS IMPORTANT SO PLEASE DON'T SKIP ANY QUESTIONS.

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ALL CHEQUES MUST BE ADDRESSED TO ANDREW BEAR AS SHOWN BELOW.

PLEASE MAKE ALL CHEQUES IN ONE OF THE FOLLOWING WAYS:
I PREFER IF YOU MAKE THE CHEQUE OUT TO JUST SIMPLY ANDREW BEAR AS IT AVOIDS UNNECESSARY HICUPPS.

FOLLOWING ARE OTHER OPTIONS:

ANDREW BEAR

C/O ABORIGINAL MENTAL HEALTH FUND

ANDREW BEAR
C/O ABORIGINAL MENTAL HEALTH INSTITUTE INC.

ANDREW BEAR
C/O BEAR AGENCY INC.

THE ADDRESS FOR ALL OF THE ABOVE IS AS FOLLOWS:


PO BOX 32090

ERINDALE POSTAL OUTLET

SASKATOON, SASK. S7S 1N8