PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on H1N1 Influenza are requested to complete this reply form by Wednesday, October 7 and mail, email or fax it to:

Elizabeth Hamlin
Assembly Committee on Health
LOB Room 822
Albany, New York 12248
Email: hamline@assembly.state.ny.us
Phone: (518) 455-4941
Fax: (518) 455- 5939

or

Estibaliz Alonso
Assembly Program and Counsel
Alfred E. Smith Bldg, Fl. 23
Albany, NY 12248
Email: alonsoe@ assembly.state.ny.us
Phone: 518-455-4311
Fax: 518-455-7095

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I plan to attend the following public hearing on H1N1 Influenza to be conducted by the Assembly Committees on Health, Labor, Education, Higher Education and the Subcommittee on Workplace Safety on October 13.
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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:


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I do not plan to attend the above hearing.
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I would like to be added to the Committees' mailing list for notices and reports.
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I would like to be removed from the Committees' mailing list.
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I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required:


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