PUBLIC HEARING REPLY FORM

Persons wishing to participate in the hearing on Preventive Services for Families are requested to complete this reply form as soon as possible and mail, email or fax it to:

Naomi Schultz
Senior Legislative Analyst
Assembly Committee on Children and Families and Social Services
Room 442 - Capitol
Albany, New York 12248
Email: contia@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693
box
I plan to attend the following hearing on Preventive Services for Families to be conducted by the Assembly Committee for Children and Families and the Committee on December 1, 2014.
box
I plan to make a public statement at the hearing. 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.
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's mailing list for notices and reports.
box
I would like to be removed from the Committee's 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: