PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on May 5 are requested to complete this reply form as soon as possible and mail or fax it to:

Renee Skorupski, Legislative Associate
Assembly Committee on Insurance
Room 520 – Capitol
Albany, New York 12248
Email: skorupr@assembly.state.ny.us
Phone: (518) 455-4928
Fax: (518) 455-5182


box I plan to attend the following public hearing on The Conversion of HIP to be conducted by the Assembly Committee on Insurance on May 5, 2005.

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.

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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.

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




NAME:

TITLE:

ORGANIZATION:

ADDRESS:

E-MAIL:

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