Health Care in New York State Prisons

PUBLIC HEARING REPLY FORM - RESPOND BY FRIDAY, NOVEMBER 7


Mail to:


Assembly Member Richard N. Gottfried, 822 LOB, Albany, NY 12248


Or fax to:


518-455-5939



box I plan to testify at the hearing on health care in New York State Prisons.

box I plan to attend, but not testify at, the hearing.

box I will require assistance and/or handicapped accessibility information. Please specify type of assistance required:


Name:

Title:

Organization (if any):

Address:

City/State/Zip:

Telephone:

Fax:

E-mail:
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