CORPORATE OFFICE: 1080 Côte du Beaver Hall Suite 2101 Montreal, Quebec, Canada H2Z 1S8 Telephone: (514) 486-3095 Facsimile: (514) 486-1317	VAL D'OR OFFICE 1745 Sullivan Road, #200 C.P. 727 Val d’Or, Quebec J9P 4P6 T: 819.824.5422 F: 819.824.7622
REGISTRAR AND TRANSFER AGENT: CIBC Mellon Trust Company 2001 University Street, Suite 1600 Montreal, Quebec, Canada H3A 2A6 Telephone: (514) 285-3600	INVESTOR & CORPORATE COMMUNICATIONS CONTACT: Leon Methot, President and Chief Executive Officer Telephone: (514) 486-3095 ext. 255 Toll Free: 1 (800) 937-3095 E-mail: lmethot@bluenotemining.ca

* indicates a mandatory field.

By entering your information on the following form you have agreed to join a subscription list that we will use to provide you with information on Blue Note Mining. This may include marketing materials, press releases or financial information. Before filling out the form, we urge you to review the sections on Disclaimer, Legal Notice and Privacy Policy on our Web-site (please click on the text links provided to review).

Title * Mr. Mrs. Ms. Miss First name * Last name * E-mail * Street

City Province / State Country * Postal / ZIP code * Telephone

Change image Please enter the code

I want to receive e-mails and other information from time to time. I am a BNT shareholder.