Health Care Disparities
PUBLIC HEARING REPLY FORM - RESPOND BY FRIDAY, APRIL 16


Mail to:
Assembly Member Richard N. Gottfried, 822 LOB, Albany, NY 12248
Or fax to:
518-455-5939


I plan to testify at the hearing on health care disparities.


I plan to attend, but not testify at, the hearing.


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





Name:

Title:

Organization (if any):

Address:

City/State/Zip:

Telephone:

Fax:

E-mail:


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