FV-259 929-Cranberries Qualification Statement Public Member/Al

OMB No. 0581-0189

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FRUIT AND VEGETABLE PROGRAM

QUALIFICATION STATEMENT

(CONFIDENTIAL)

Cranberry Marketing Committee – Public Member and Alternate

The following information will be used by the Secretary of Agriculture in selecting a Public Member representative to serve on the Cranberry Marketing Committee. The Cranberry Marketing Committee administers Federal Marketing Order No. 929, which regulates the handling of cranberries grown in Massachusetts, Rhode Island, Connecticut, New Jersey, Wisconsin, Michigan, Minnesota, Oregon, Washington, and Long Island in the State of New York.

Name:

Mailing Address:

Town/City: _____________________________________ State: _____ Zip Code: __________

Telephone: (H) ________________________________ (W) ___________________________________

Fax: ______________________________________ Email: ____________________________________

Educational Background:

Occupation: (Employer's Name & Address):

Briefly state your qualifications and why you are interested in serving as the public and alternate member on the Committee.

Briefly state your past and current work (service) with public groups. Please indicate offices held, etc.

Please list dates and give a brief summary of any other experience you believe would be pertinent. If a student, please state your major and minor course of study.

Please list the organizations to which you belong or are affiliated:

Do you or members of your immediate family have financial interest in or close association with the production, processing, financing, or marketing of agricultural commodities? Yes  No:

NOTE: The public member and alternate public member are not salaried positions. However, authorized travel expenses, while on Committee related business, are reimbursable.

I hereby certify that I am qualified to serve on the Cranberry Marketing Committee. If selected by the Secretary, United States Department of Agriculture, I will carry-out the duties of this position as defined in the Cranberry Marketing Order to the best of my ability.

Signature: __________________________________________ Date: ___________________________

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FV-259 (Rev. 9/13. Destroy previous editions.)