REG TECHNOLOGIES INC.

Request for Printed Copies of Annual and Interim Financial Statements and MD&A

In accordance with National Instrument 51-102, Continuous Disclosure Obligations, the registered and

beneficial owners of our shares may request a copy of our annual financial statements and management

discussion and analysis (“MD&A”), our interim financial statements and MD&A, or both.

If you wish to receive printed copies of any of these documents, please indicate your request by completing

this form and returning it to:

Equity Corporate Services Inc.

1185 West Georgia Street, Suite 1620

Vancouver, BC V6E 4E6

As an alternative to receiving these financial statements and MD&A by mail, you may view them on our

profile on SEDAR at www.sedar.com.

The undersigned shareholder hereby elects to receive:

o A. Please send me the annual financial statements and MD&A.

o B. Please send me the interim financial statements and MD&A.

o C. Please send me both A and B.

Please note that a request form will be mailed each year and shareholders must return such form each

year to receive the documents indicated above.

I confirm that I am a registered and/or beneficial holder of shares of the Company.

Signature

Name (Please Print)

Address

(include postal code)

Date

To use electronic methods for communication with our shareholders, we request that you provide us with your

email address. Please insert your e-mail address and initial and date below to indicate your consent to receive

information by e-mail instead of in paper form.

I HEREBY CONSENT to receipt of information by e-mail as the following address:

E-mail address

Meeting Date: August 17, 2011

REG TECHNOLOGIES INC 6-K