PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on Wednesday, June 7, 2006 are requested to complete this reply form as soon as possible and mail it to:

Jennifer Best
Committee Assistant
Assembly Committee on Mental Health, Mental Retardation and Developmental Disabilities
Room 522, Capitol
Albany, New York 12248
Email: bestj@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693


box I plan to attend the public hearing on assessing the needs of New Yorkers diagnosed with both a developmental and psychiatric disability to be conducted by the Assembly Committee on Mental Health, Mental Retardation and Developmental Disabilities and the New York State Task Force on People with Disabilities on Wednesday, June 7, 2006.

box I plan 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:

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