Consolidation in the Health Insurance Industry - Public Hearing Reply Form

Respond by November 16 for the Syracuse hearing or November 27 for the New York City hearing.
Mail to: Assembly Committee on Health, 822 Legislative Office Building, Albany, NY 12248
Or fax to: 518-455-5939


box I plan to testify at the
      box  Syracuse hearing
      box  New York City hearing

box I plan to attend, but not testify at, the
      box  Syracuse hearing
      box  New York City hearing

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


NAME:

TITLE:

ORGANIZATION:

ADDRESS:

E-MAIL:

TELEPHONE:

FAX TELEPHONE: