PUBLIC HEARING REPLY FORM Persons wishing to present testimony at the public hearing on New York State’s response to viral hepatitis are requested to complete this reply form as soon as possible and mail it to:
Bill Eggler |
|
|
|
I plan to attend this public hearing | |
|
|
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. | |
|
|
I will address my remarks to the following subjects:
|
|
|
|
I would like to be added to the Committee mailing list for notices and reports. | |
|
|
I would like to be removed from the Committee mailing list. | |
|
|
I will require assistance and/or handicapped accessibility information. Please specify the
type of assistance required: |
|
|
|
|
NAME: |
|
|
|
TITLE: |
|
|
|
ORGANIZATION: |
|
|
|
ADDRESS: |
|
|
|
TELEPHONE: |
|
Back |