How to prepare legal forms (click here)

Revocable Proxy

For payment of one dollar ($1) and other compensation, I hereby confer upon ___________ a proxy to vote _________ ( ___ ) shares of _________ (hereinafter "Corporation") in my stead and on my behalf at the Corporation shareholders' meeting to be held on ___________, 20 __, and at all subsequent regular and special meetings of shareholders of the Corporation. Said person shall have all the power to vote and attend meetings as I currently enjoy. Until this proxy is revoked, which act may be executed without notice, I shall not vote the shares represented.

Date: ______________.

_______________________________

Signed