PUBLIC HEARING REPLY FORM

Persons invited to present testimony at the public hearing on Natural Gas and Oil Development to be held on November 16, 2004, or who wish to submit written testimony only, are requested to complete and return this reply form by November 4, 2004 by mail or fax to:

Jeff O'Donnell
Committee Assistant
New York State Assembly
Program & Counsel Staff
Capitol/ Room 520
Albany, NY 12248
Email: odonnej@assembly.state.ny.us
Phone: (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.)


I plan to attend the following public hearing on November 16, 2004 to be conducted by the Assembly Committee on Environmental Conservation.

I have been invited to make a public statement at the hearing. My statement will be limited to 5 minutes, and I will answer any questions which may arise. I will provide 10 copies of my prepared statement.

I will address my remarks to the following subjects:




I do not plan to attend the above hearing.

I would like to be added to the Committee mailing list for notices and reports.

I would like to be removed from the Committee mailing list.

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




NAME:

TITLE:

ORGANIZATION:

ADDRESS:

TELEPHONE:

E-MAIL:

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