PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on access to services for individuals with Autism Spectrum Disorder (ASD) are requested to complete this reply form as soon as possible and mail it to:

Katie L. Birchenough
Analyst
Assembly Committee on Mental Health,
Mental Retardation and Developmental Disabilities
Room 520 - Capitol
Albany, New York 12248
Email: birchenoughk@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693
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I plan to attend the following public hearing on access to services for individuals with Autism Spectrum Disorder (ASD) on February 10th, 2011.
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I plan to make a public statement at the hearing on February 10th, 2011. 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:


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I do not plan to attend the above hearing.
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I would like to be added to the Committees' mailing list for notices and reports.
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I would like to be removed from the Committees' mailing list.
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I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required:


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