FV-650 929-Cranberry Mktng. Cmte. Member & Alternate Member Nom

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL 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 Marketing Committee (the “Committee”) to represent growers from the Cranberry Marketing Order District No. ______ who are not from major cooperatives, during the two year term commencing August 1, 20___. Nominees will have their names placed on a ballot that will be voted on by growers who are not affiliated with major cooperatives from the Cranberry Marketing Order District No. _____, to determine which nominee(s) will be elected to serve as member(s) and alternate member(s), subject to final selection by the Secretary of Agriculture of the U.S. Department of Agriculture.

NOMINEES

(PRINT NAMES)

I am a grower that produces cranberries in District No. ________. (Please specify District Number.)

District 1: the States of Massachusetts, Rhode Island and Connecticut; District 2: the States of New Jersey and Long Island in the State of New York; District 3: the States of Wisconsin, Michigan and Minnesota; and District 4: the States of Oregon and Washington.

Name of person making nomination

Signature of person making nomination

Nominations must be postmarked by _________ in order to be counted.

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 0581-0189. 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 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.

FV-650 (Rev. 7/10. Destroy previous editions.)