PUBLIC HEARING REPLY FORM
Persons wishing to present testimony at the public hearing on Health Equity & Disparities in Primary Care Referrals by Academic
Medical Centers are requested to complete this reply form as soon as possible, but no later than Monday, May 7, email or fax it to:
I plan to attend the following public hearing on Illegal Hotels to be conducted by the Assembly Committee on Housing on April 27, 2012.
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.
I will address my remarks to the following subjects:
I would like to be added to the Committeemailing 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: