FV-259 929-Cranberries Qualification Statement public Member/Al

UNITED

STATES

DEPARTMENT

AGRICULTURAL
FRUIT
&

OF

MARKETING
VEGETABLE

QUALIFICATION

AGRICULTURE

OMS No. 0581-0189

SERVICE
DIVISION

STATEMENT
ICONRDEN11AL)

CranberryMarketingCommittee-Public Memberand Alternate
The followinginformationv.;Hbe used by the Secretaryin selectinga Public Member representativeto serve on the Cranberry
MarketingCoovnittee. The Crar1befTy
MarketingCoornittee aaninisters the FederalMarketing OrOOr929, which regulatesthe
handling of cranberriesgrown in Massachusetts,Rhode Island,Connecticut, New Jersey, Wisconsin,Michigan, Minnesota,
Oregon,Washington,and Long Island in the Stateof Ne~'York.

PlEASE

PRINT ()R TYPE ALL RESPONSES

Name:

MailingAddress:
State:

Town/City:
Telephone:

Home~ (

Zip Code:

WOf1c.~
E-mail

Fax#: (

Educational Background:

Occupation: (Employer's
Name& A<*iress)

Briefly state your qualifications and wtJyyou are interested lin serving as the public alternate member on the Committee.

Briefly state your past and current work (service)

with public groups.

Please indicate offICes held, etc.

Please list ~tes and give a brief summary of any other experience you believe would be pertinent. If a student, please state
your major and minor course of study

QUAUFICA TION STATEMENT
Page 2
Listorganizations
to wh~ youbeongor are affifiated:-

Doyouor merrbersofyourirrvnediate
familyhavefinancialinterestin or ck>seassociation
withthe production,
processing,
financing,or marketingofagricultural
commodities?
OY.~ 0 No:

Please Note.
The public member and alternate public member are not salaried positions.
authorized travel expenses, while on Committee related business, are reimbursable.

However,

I herein certify that I am qualified to serve on the Cranberry Marketing Committee. If selected by the
Secretary, United States Department of Agriculture, I will carry-out the duties of this position as defined in
the Cranberry Marketing Order to the best of m~' ability.

Signature:

i

Date:

Accordingto the PaperworkReductionAct of 1995,an agetx:ymay not conductor sponsor,and a personis not
requiredto respondto a collection of infommtionunlessit displaysa valid OMB controlnumber. The valid OMB
control nwnberfor this information collectionis 0581-0189. The time requiredto completethis information
collectionis estimatedto avemge5 minutesper respclnse,
including the time for reviewing instructions,searching
existingdatasources,gatheringand maintainingthe datareeded,and completingand reviewingthe collection of

information.
The U.S. Departmentof Agriculture (USDA) prohibits discriminationin all its programsand activities on the basis
of race,color, nationalorigin, age,disability, andwhereapplicable,sex, maritalstatus,familial status,parentalstatus,
religion, sexualorientation,genetic infonnation,political beliefs, reprisal,or becauseall or part of an individual's
income is derived from any public assistanceprograIltl(Not all prolubitedbasesapply to all programs.)Personswith
disabilitieswho requirealternativemeansfor communicationof program infomlation (Braille, large print, audiotape,
etc.) shouldcontactUSDA's TARGET Centerat (202) 720-2600(voice androD).
To flie a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400IndependenceAvenue, SW,
Washington,DC 20250-9410or call (800)795-3272(voice) or (202) 720-6382(TDD). USDA is an equalopportunity
providerand employer.
FV-259(05/07)