LS-35 Nomination of Pork Producers or Importers for Appointmen

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U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

NOMINATION OF PORK PRODUCERS OR IMPORTERS FOR APPOINTMENT
TO THE NATIONAL PORK PRODUCERS DELEGATE BODY
Pursuant to the Pork Promotion, Research, and Consumer Information Act of 1985, the following names of pork producers are
submitted as nominees for appointment to the National Pork Producers Delegate Body as representatives of the State indicated.
Nominations by individual producers or importers must be accompanied by a written petition as required by the Act.
1. STATE/UNIT

2. NAMES(S) OF NOMINEE(S)
(List name(s) for each allotted position on the Delegate Body)

IF MORE SPACE IS NEEDED, USE ADDITIONAL FORMS.
3. IDENTIFICATION OF PERSON AND ORGANIZATION/ASSOCIATION SUBMITTING THESE NOMINATIONS
A. NAME AND ADDRESS OF ORGANIZATION/ASSOCIATION (or Name &
Address of individual if NOT representing an organization) (Type or Print)

B. NAME AND TITLE OF ORGANIZATIONAL REPRESENTATIVE
(Type or Print)

TELEPHONE NO AND AREA CODE

SIGNATURE (Organizational Representative OR
Individual Submission)

DATE

E-MAIL ADDRESS ([email protected])

RETURN FORM AND BIOGRAPHICAL DATA FORMS (AD-755)TO:
National Pork Board
Post Office Box 9114
Des Moines, Iowa 50306
LS-35

FACSIMILE NO AND AREA CODE