PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on the rising rate of autism in New York State are requested to complete this reply form as soon as possible and mail it to:

Amy Nickson
Legislative Analyst
Assembly Committee on Mental Health, Mental Retardation and Developmental Disabilities
Room 522 - Capitol
Albany, New York 12248
Email: nicksoa@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693


box I plan to attend the public hearing on the rising rate of autism in New York State to be conducted by the Assembly Committee on Mental Health, Mental Retardation and Developmental Disabilities and the Senate Committee on Mental Health and Developmental Disabilities on Thursday, March 8, 2007.

box I plan to make a public statement at the hearing. My statement will be limited to 10 of 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:



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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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