MAN-BAL Mangos Foreign Producer Nomination Ballot

OMB No. 0581-0093

NATIONAL MANGO BOARD (7 CFR 1206)

FOREIGN PRODUCER NOMINATION BALLOT

The nominees listed on this ballot are seeking a seat on the National Mango Board (NMB). As a foreign producer, you are asked to vote for xxx candidates. Please mark your selection and completely fill in the information requested.

Mail this ballot for it to be received by NMB on or before XX, 20XX. Submissions received after this date will not be counted.

NATIONAL MANGO BOARD

Street

City, State Zip Code

Please select XXX names from the list of nominees:

 XXX

 XXX

 XXX

 XXX

Certification Statement

I certify that I exported Mangos to the United States at the location listed below during the twelve-month period of January 1, 20XX through December 31, 20XX.

(Please type or print)

Company/Business Name:________________________________________________________

Name:________________________________________________________________________

Title:__________________________________________________________________________

Address: ______________________________________________________________________

City: _____________________________ State: ________________Zip code: _______________

Signature: __________________________________ Date: ___________________

DIVERSTIY STATEMENT

The National Mango Board (NMB) encourages industry members without regard to race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, size of business/operation, and marital or family status or other basis protected by U.S. law to participate in NMB activities and seek a position on the NMB.

(Continued on Back Page)

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 15 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.

MAN-BAL (08/10) Destroy previous editions.

(Foreign Producer)