PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on February 7th are requested to complete this reply form by Thursday, December 13th and mail it to:

Jennifer Best
Legislative Analyst
Assembly Committee on Aging
Room 522- Capitol
Albany, New York 12248
E-mail: Bestj@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693


box I plan to attend the following public hearing on the Abuse and Exploitation of Vulnerable Elderly Citizens to be conducted by the Assembly Committee on Aging on Monday, December 17th.

box I plan to make a public statement at the hearing. My statement will be limited to 5 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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