PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on Closures of state-operated OMH and OPWDD facilities are requested to complete this reply form as soon as possible and mail, email or fax it to:

Katie L. Birchenough
Legislative Analyst
Assembly Committee on Mental Health and Developmental Disabilities
Room 422 - Capitol
Albany, New York 12248
Email: birchenoughk@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693
box
I plan to attend the following public hearing on Closures of state-operated OMH and OPWDD facilities to be conducted by the Assembly Committee on Mental Health and Developmental Disabilities on September 13, 2013.
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: