PUBLIC HEARING REPLY FORM


Persons wishing to present testimony at the public hearing on Preventing Childhood Obesity at School, Home and in the Community are requested to complete this reply form as soon as possible and mail it to:

    Robert Stern
    Assembly Task Force on Food, Farm and Nutrition Policy
    Agency #4, 5th floor
    Albany, New York 12248
    Phone: (518) 455-5203;
    fax: (518) 455-5573;
    e-mail: sternr@assembly.state.ny.us


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I plan to attend the public hearing on Preventing Childhood Obesity at School, Home and in the Community to be conducted by the Assembly Task Force on Food, Farm and Nutrition Policy on (circle one):

Thurs., April 3, in Hauppauge, NY
Friday, April 4, in White Plains, NY

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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.


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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 Task Force mailing list for notices and reports.

box I would like to be removed from the Task Force mailing list.

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I will require assistance and/or handicapped accessibility information. Please specify the type of assistance required:


PLEASE PRINT!


NAME:

TITLE:

ORGANIZATION:

ADDRESS:

TELEPHONE:

e-mail:


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