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Registration for Intervenor StatusAll information provided on this form will be placed on the public registry for this project.

Hard copy submissions may be made by mail, courier, hand delivery or fax at the address below.Secretary to the Joint Review PanelJoint Review Panel - Enbridge Northern Gateway Project444 Seventh Avenue S.W.Calgary, Alberta T2P 0X8

Facsimile: 403-292-5503, or toll free at 1-877-288-8803

Hearing Information

File Number:

Date:

Project Name:

Hearing Order No:

Intervenor Information

Name:

Title:

Organization:

Telephone:

Facsimile:

Address:

City:

Province:

Postal Code:

Email:

11/07/2011

Enbridge Northern Gateway Pipeline Project

OF-Fac-Oil-N304-2010-01 01OH-4-2011

Ruth Gladstone-Davies POB 1301

Skidegate, Haida Gwaii

BC

V0T 1S1

[email protected]

Skidegate Band Council

Financial Assistance Worker

(250) 559-2316

(250) 559-0002

Address for Courier/Personal Service: (if different from mailing address)

Address: Telephone:#458 Skidegate Hgts POB 1431

V0T 1S1

(250) 559-9007Skidegate, Haida Gwaii, BC

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Issues and Interests

What topics on the list of issues are you interested in?

Socio-economic EffectsConsultationPotential Impacts of the Proposed Project

Do you intend to actively participate during the hearings? Yes No

No YesWill someone be speaking on your behalf? Unknown

Unknown

Representative InformationIf you do not have someone speaking on your behalf, please leave blank.

Name:

Title:

Organization:

Telephone:

Facsimile:

Address:

City:

Province:

Postal Code:

Email:

Address for Courier/Personal Service: (if different from mailing address)

Address: Telephone:

Access, Notification and Service

Which official language do you wish to use in correspondence withthe Panel and at the public hearing?

English French

Documents submitted electronically are available on the Panel's registry (gatewaypanel.review.gc.ca). If you can access thepublic registry, the Panel and other Parties in this hearing may send you notification that a document has been submitted and isavailable in the public registry, instead of sending you a hard copy of the document.

Do you have the capability to access the Panel's registry? No Yes

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Participation at the Hearing

Intervenors wishing to give evidence must submit their written evidence with the Panel and send a copy to all Parties by thedeadline indicated in the Timetable of Events in the Hearing Order.

Will you be submitting written evidence? Yes No

Do you intend to question the Applicant or Intervenors on their evidence? Yes No

Do you require a paper copy of the daily transcripts?(Note: You may view the transcripts through the Panel's website at

gatewaypanel.review.gc.ca)

Yes No

Do you wish to request permission from the Panel to provide oral evidence? Yes No

Upon request, the Panel will allow oral evidence where it consists of oral traditional evidence or evidence that cannot be providedin writing, and it can be presented in three hours or less, unless advance notice is given to the Panel. Any written documentsshould be submitted as written evidence and not read onto the record as oral evidence.

Unknown

Unknown

Unknown

Unknown

The Panel will decide whether to allow oral evidence after it receives the following information that may beprovided now or no later than 6 October 2011.

1) Your reason for making the request:

2) The time expected to give your oral evidence:

3) Overview of the evidence that you propose to provide orally:

4) Identify the individuals who will provide this oral evidence:(Optional - this information may be provided at a later date if not currently known)

** I understand that if I wish to present oral evidence to the Panel in a language other than English or French, such asan Aboriginal language, I must identify an interpreter and contact Louise Niro, Regulatory Officer at 403-299-3987 ortoll free at 1-800-899-1265. Please specify the Enbridge Northern Gateway Project and that you would like to makearrangements to provide interpretation of the presentation into English or French. It is preferable if the interpreter canprovide simultaneous interpretation into English or French, but consecutive interpretation may be accepted. TheEnglish interpretation will be transcribed and used as the evidentiary record for the joint review process.

5) Which language would you like to present your oral evidence in?

English French **Other Please Name:

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