HOW TO ACHIEVE UNIVERSAL HEALTH COVERAGE IN NEW YORK STATE
PUBLIC HEARING REPLY FORM

Please respond by December 4 for the Albany hearing or December 7 for the New York City hearing.

Mail to: Assembly Committee on Health, Legislative Office Building, Rm. 822, Albany, NY, 12248
Or fax to: 518-455-5939


box I plan to testify at the

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Albany hearing Friday, December 8

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New York City hearing Tuesday, December 12

box I plan to attend, but not testify at, the

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Albany hearing Friday, December 8

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New York City hearing Tuesday, December 12

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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:
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