PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on Prison Mental Health Initiatives are requested to complete this reply form as soon as possible and mail it to:

T.J. Conteh
Legislative Associate
Assembly Committee on Correction
Room 508 - Capitol
Albany, New York 12248
Email: conteh@assembly.state.ny.us
Phone: (518) 455-4313
Fax: (518) 455-4682


box I plan to attend the following public hearing on Prison Mental Health Initiatives to be conducted by the Assembly Committee on Correction on January 18, 2006.

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



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:

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ADDRESS:

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