PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on employee misclassification on January 27th are requested to complete this reply form as soon as possible and mail, e-mail or fax it to:

Dallas Trombley
Alfred E Smith Office Building
23rd Floor, Albany, NY 12248
(518) 455-7095 (fax)
Trombld@Assembly.state.ny.us (518) 455-4311 (phone)
box
I would like to testify at the hearing on January 27th, 2010.
box
I plan to attend, but do not wish to testify at the hearing on January 27th, 2010.
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: