PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on combating the "silent epidemic" of prescription drug abuse are requested to complete this reply form as soon as possible and mail it to:

Bill Eggler
Senior Legislative Analyst
Assembly Committee on Alcoholism and Drug Abuse
Room 522 - Capitol
Albany, NY 12248
Email: egglerw@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693


box I plan to attend the following public hearing on the "silent epidemic" of prescription drug abuse to be conducted by the Assembly Committees on Alcoholism and Drug Abuse and Health on January 13.

box I plan 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.

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I will address my remarks to the following subjects:

1.

2.

3.

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:

TELEPHONE:

FAX TELEPHONE:
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