PUBLIC HEARING REPLY FORM

Persons invited to present testimony at the public hearing on Water Quality in the Adirondacks to be held on September 27, 2005, or who wish to submit written testimony, are requested to complete and return this reply form by September 16, 2005 by mail or fax to:

Alex Roth
Principal Legislative Analyst
New York State Assembly
Program & Counsel Staff
Capitol/ Room 520
Albany, NY 12248
(518) 455-4363
fax (518) 455-5182

(It is important that the reply form be fully completed and returned so that persons may be notified in the event of emergency postponement or cancellation.)


box I plan to attend the public hearing on September 27, 2005 concerning the Water Quality in the Adirondacks to be conducted by the Assembly Committee on Environmental Conservation.

box I have been invited 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 mailing list for notices and reports.

box I would like to be removed from the Committee 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:
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