PUBLIC HEARING REPLY FORM
Persons invited to present testimony at the public hearing on the health impacts of hydraulic fracturing to be held on May 26, 2011, or who wish to submit written testimony, are requested to complete this reply form as soon as possible and mail, email or fax it to:
Michael Szydlo
Committee Assistant
Assembly Committee on Environmental Conservation
Room 520 - Capitol
Albany, New York 12248
Email: szydlom@assembly.state.ny.us
Phone: (518) 455-4363
Fax: (518) 455-5182
I plan to attend the public hearing on hydraulic fracturing to be conducted by the
Assembly Committee on Environmental Conservation on May 26, 2011.
I have been invited to make a public statement at the hearing. My statement will be limited to
ten 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 do not plan to attend the above hearing.
I would like to be added to the Committees' mailing list for notices and reports.
I would like to be removed from the Committees' mailing list.
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: