PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at this public hearing on the Home Energy Assistance Program (HEAP) are requested to complete this reply form as soon as possible and mail it to:

Brian Snowdon
Legislative Analyst
Assembly Committee on Energy
Room 520 - Capitol
Albany, New York 12248
Email: snowdob@assembly.state.ny.us
Phone: (518) 455-4363
Fax: (518) 455-5182


box I plan to attend the following public hearing on the 2006-2007 HEAP Budget conducted by the Assembly Committees on Energy.

box I plan to submit written testimony at the hearing. 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:

ORGANIZATION:

ADDRESS:

E-MAIL:

TELEPHONE:

FAX TELEPHONE:
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