1 AEB & 2 AEB Eggs Nomination Selections

OMB No. 0581-0093

NOMINATION FORM

AMERICAN EGG BOARD — 20__-20__ TERM

AREA ___

Nomination for Member and Alternate: List first and second choice for member and alternate. Four separate names must be listed for the nomination schedule to be accepted.

Member

1^st choice _____________________________ _____________________

Name Daytime Phone

_____________________________

City & State

2^nd choice _____________________________ _____________________

Name Daytime Phone

_____________________________

City & State

Alternate

1^st choice _____________________________ _____________________

Name Daytime Phone

_____________________________

City & State

2^nd choice _____________________________ _____________________

Name Daytime Phone

_____________________________

City & State

Caucus Leader for next year (20__): ________________________________ ________________________________

1-AEB

(Name) (Organization)

(OVER)

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 collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0093. The time required to complete this information collection is estimated to average 30 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 Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

N

OMB No. 0581-0093

OMINATION FORM

AMERICAN EGG BOARD — 20__-20__ TERM

AREA ___

Nomination for Member and Alternate: List first and second choice for member and alternate. Four separate names must be listed for the nomination schedule to be accepted.

Member A Alternate A

1^st choice __________________________ 1^st choice __________________________

Name Name

__________________________ __________________________

Daytime Phone Daytime Phone

__________________________ __________________________

City & State City & State

2^nd choice __________________________ 2^nd choice __________________________

Name Name

__________________________ __________________________

Daytime Phone Daytime Phone

__________________________ __________________________

City & State City & State

Member B Alternate B

1^st choice __________________________ 1^st choice __________________________

Name Name

__________________________ __________________________

Daytime Phone Daytime Phone

__________________________ __________________________

City & State City & State

2^nd choice __________________________ 2^nd choice __________________________

Name Name

__________________________ __________________________

Daytime Phone Daytime Phone

__________________________ __________________________

City & State City & State

Caucus Leader for next year (20__): ________________________________ ________________________________

2-AEB

(Name) (Organization)

(OVER)

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 collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0093. The time required to complete this information collection is estimated to average 30 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 Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.