PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on New York State's response to hepatitis A, B and C and methamphetamine are requested to complete this reply form as soon as possible and mail it to:

Bill Eggler
Legislative Associate
Assembly Committee on Alcoholism and Drug Abuse
Room 522 - Capitol
Albany, New York 12248
Email: egglerw@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693


box I plan to attend the following public hearing on New York State's response to hepatitis A, B and C and methamphetamine to be conducted by the Assembly Committees on Alcoholism and Drug Abuse and Health on January 7, 2005.

box I plan to make a public statement at the hearing. My statement will be limited to 5 minutes, and I will answer any questions which may arise. I will provide 10 copies of my prepared statement.

box I will address my remarks to the following subjects:



box I do not plan to attend the above hearing.

box I would like to be added to the Committee mailing list for notices and reports.

box I would like to be removed from the Committee mailing list.

box

I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required:




NAME:

TITLE:

ORGANIZATION:

ADDRESS:

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