PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on Treatment of Autism Spectrum Disorder are requested to complete this reply form as soon as possible and mail or fax it to:

Cillian Flavin
Principal Committee Assistant
Assembly Committee on Insurance
23rd Floor - Alfred E. Smith Office Building
Albany, New York 12248
E-mail: flavinc@assembly.state.ny.us
Phone: (518) 455-4311
Fax: (518) 455-7095


box I plan to attend the following public hearing on coverage for the early intervention, diagnosis and treatment of Autism Spectrum Disorder in New York to be conducted by the Assembly Committee on Insurance on December 18, 2008.

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.

box 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.

box

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






NAME:

TITLE:

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