PUBLIC HEARING REPLY FORM

Persons invited to present testimony at the public hearing on The Impact of Escalating Prices in Electricity, Natural Gas and other Fuels on Businesses to be held on October 12, 2005, or who wish to submit written testimony only, are requested to complete and return this reply form to:

Jennifer Cossu
Committee Assistant
Assembly Committee on Energy
Room 520 - Capitol
Albany, New York 12248
Phone: (518) 455-4363
Fax: (518) 455-4128


box I plan to attend the public hearing on the Impact of Escalating Prices in Electricity, Natural Gas and other Fuels on Businesses to be conducted by the Assembly Committee on Energy on October 12, 2005.

box I have been invited 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.

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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.

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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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