PUBLIC HEARING REPLY FORM
Persons wishing to present testimony at the public hearing on Mercury Exposure are requested to complete this reply form as soon as possible and mail, e-mail or fax it to:
Kali Michael
Committee Assistant
Assembly Committee on Environmental Conservation
Room 520 Capitol
Albany, New York 12248
E-mail: michaelk@assembly.state.ny.us
Phone: (518) 455-4363
Fax: (518) 455-5182
I plan to attend the following public hearing on Mercury Exposure to be conducted by the Assembly Committee on Environmental
Conservation on October 13, 2009.
I plan to make a public statement at the hearing. My statement will be limited to ten 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:
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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:
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NAME:
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TITLE:
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ORGANIZATION:
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ADDRESS:
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E-MAIL:
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TELEPHONE:
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FAX TELEPHONE:
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