FV-650 929-Cranberry M.O. Member & Alternate Member Ballot

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LOCALLY.

Include form number and date on all reoroductions.

OMB No. 0581-0189

UNITED STATES DEPARTMENT OF AGRICULTIJRE
AGRICULTIJRAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

Cranberry Marketing Committee
Member and Alternate Member Nomination Form
I hereby nominate the following person(s) as nominee(s) to serve on the Cranberry MarketingCommittee(CMC)to represent
growers from other than the major cooperative from CMO District
during thetwo yearterm commencingAugust1,20
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Nominees will have their names placed on a ballot that will be voted on by growers affiliated with other than the major

_

cooperative from CMO District
to determine which nominee will be elected to serve as member(s) and alternative
member, subject to final selection by the Secretary, USDA.

NOMINEES
(PRINT NAMES)

I am a grower that produces cranberries in District
. Please specify District Number: District 1 - the States of
Massachusetts, Rhode Island and Connecticut; District2 - the States of New Jersey and LongIslandinthe Stateof NewYork;
District 3 - the States of Wisconsin, Michigan and Minnesota; and District 4 - the States of Oregon and Washington.

(Name of person making nomination -please print)

(Signature of person making nomination)
Nominations

must be received no later than

. Nominations received after

willnot be considered.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collectionofinformalion
unless it displays a valid OMS control number. The valid OMS control number for this information collection is 0581-018 9. The time required to complete this
information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information.
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 status, parental 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 who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET
Centerat (202) 720-2600 (voice and TOD). To filea complaintof discrimination,write to USDA, Director, Office of CiVilRights, 1400 Independence
Avenue, SW., Washington, D.C. 20250-9410, or call (BOO)795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and
employer.

FV-650 (05/07)