PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on May 23, 2006 are requested to complete this reply form as soon as possible and mail it to:

Bryan O'Malley, Legislative Associate
Assembly Committee on Health
Room 822, Legislative Office Building
Albany, New York 12248
Email: omalleb@assembly.state.ny.us
Phone: (518) 455-4941
Fax: (518) 455-5939


box I plan to attend the following public hearing on Fair Share for Health Care to be conducted by the Assembly Committees on Health, Insurance and Labor on May 23, 2006.

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

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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.

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




NAME:

TITLE:

ORGANIZATION:

ADDRESS:

E-MAIL:

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