PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on the prevention of underage alcohol consumption are requested to complete this reply form as soon as possible and mail it to:

Willie Sanchez
Analyst
Assembly Committee on Alcoholism and Drug Abuse
Room 520 - Capitol
Albany, New York 12248
Email: sanchezw@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693
box
I plan to attend the public hearing on the prevention of underage alcohol consumption on Wednesday, May 25th, 2011.
box
I plan to make a public statement at the hearing on Wednesday, May 25th, 2011. 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's mailing list for notices and reports.
box
I would like to be removed from the Committee's 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: