MAN-BAL Mangos Importer Nomination Ballot

OMB No. 0581-0093

NATIONAL MANGO BOARD (7 CFR 1206)

IMPORTER NOMINATION BALLOT

The nominees listed on this ballot are seeking a seat on the National Mango Board (NMB). As a mango importer, you are asked to vote for candidates in District (X). There are X positions available for District X. The individual receiving the highest vote totals will be considered the first-choice of the industry for the vacant position and the next one will be considered the second-choice for the position. Please mark your selections 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 for District I:

XXXX  XXXX 

XXXX  XXXX 

Please select XXX names from the list of nominees for District II:

XXXX  XXXX 

XXXX  XXXX 

Please select XXX names from the list of nominees for District III:

XXXX  XXXX 

XXXX  XXXX 

Please select XXX name from the list of nominees for District IV:

XXXX  XXXX 

XXXX  XXXX 

Certification Statement

I certify that I imported 500,000 pounds or more of Mangos 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: ___________________

(Continued on Back Page)

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.

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.

(Importer)