920-Kiwifruit Official Nomination Form

OMB# 0581-0189

KIWIFRUIT ADMINISTRATIVE COMMITTEE
OFFICIAL NOMINATION FORM
DISTRICT #
For your information, listed below are the incumbent Kiwifruit Administrative Committee (KAC) members for this district:
Incumbent Member:

Incumbent Name

Incumbent Alternate Member:

Incumbent Name

We ask that you be mindful of the Department's policy regarding Equal Employment Opportunity and Civil Rights and
consider eligible women, minorities, and the physically challenged for membership on the Committee.
If you want to nominate a grower, or their employee, and are unsure if they qualify in your district, please call our office at
(559) 638-5951. Nomination forms must be postmarked no later than

PLEASE PRINT THE NAME OF YOUR NOMINEE(S) IN THE SPACE PROVIDED BELOW. TO BE ELIGIBLE TO
SERVE ON THE KAC, A NOMINEE MUST CURRENTLY BE PRODUCING KIWIFRUIT FOR MARKET, OR AN
EMPLOYEE OF A CURRENT PRODUCER. ALL QUALIFIED NOMINEES FOR EACH POSITION WILL APPEAR ON
THE FORTHCOMING BALLOT TO BE MAILED TO ALL KIWIFRUIT GROWERS, RESPECTIVE OF DISTRICTS.

MEMBER NOMINEE:
NAME

ALTERNATE MEMBER NOMINEE:
NAME

Nominator's Comments: (use reverse side of form if more space is required)

NOMINATOR'S CERTIFICATION STATEMENT: I certify that I am currently a kiwifruit grower and that to the best of my
knowledge, the above nominees are currently kiwifruit growers or employees of growers in this district.

Signature:
Name:

Phone No.:

Address:

PLEASE COMPLETE THE NOMINATION FORM AND RETURN IT IN THE ENCLOSED PRE-ADDRESSED ENVELOPE
TO THE KAC. INCOMPLETE FORMS OR FORMS POSTMARKED LATER THAN
MAY BE
INVALIDATED. PLEASE CALL THE KAC AT (559) 638-5951 IF YOU HAVE ANY QUESTIONS.
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The U.S. Department of Agriculture (USDA) prohibits discrimination
in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial slatus,
paren/al status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program (Not all prohibited bases apply to all
programs.)
Persons with disabilities »110 require altemati"" means for communication
of program infonnation (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (101) 710-1600 (voice and
TDD). To file a complaint of discrimination,
write to USDA, Dire<:tor, Office of Civil Rights, 1400 Independence Avenue, S. W., Washington, D.C. 10150-9410, or call (800) 795-3171 (voice) or (101) 710-6381 (fDD).
USDA is an equal opportunity provider and employer.

OMB# 0581-0189

DISTRICT

CANDIDATES STATEMENTS

Candidate Name't Member Candidate't Seat 1
(Statement)

Candidate Name't Alternate Member Candidate't Seat 1
(Statement)

Candidate Name't Member Candidate't Seat 2
(Statement)

Candidate Name't Alternate Member Candidate't Seat 2
(Statement)