LS-84 Nomination for Appointment to the Lamb Board

REPRODUCE LOCALLY. Include form number and edition date on all reproductions.

FORM APPROVED - OMB NO. 0581-0093

Please mark an "X" in appropriate block:

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

Producer
Seedstock Producer

NOMINATION FOR APPOINTMENT TO THE LAMB

Feeder

PROMOTION, RESEARCH, AND INFORMATION BOARD

First Handler
NOTE: 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.

NOTE: Information is collected to obtain names of nominees for appointment as members of the Board. Response is voluntary.
Pursuant to the Lamb Promotion, Research, and Information Order, the following names are submitted as nominees.
NAME(S) OF NOMINEE(S)
(List name(s) for each allotted position on the Board)

IF MORE SPACE IS NEEDED, USE ADDITIONAL FORMS. A COMPLETED ADVISORY COMMITTEE BACKGROUND INFORMATION FORM SIGNED BY EACH
NOMINEE MUST BE ATTACHED.
WHEN NOMINATIONS ARE THE RESULT OF A CAUCUS, LIST THE CERTIFICATION NUMBERS OF ORGANIZATIONS OR ASSOCIATIONS PARTICIPATING IN
THE CAUCUS.
A.

E.

I.

B.

F.

J.

C.

G.

K.

D.

H.

L.

IDENTIFICATION OF PERSON AND ORGANIZATION/ASSOCIATION SUBMITTING THESE NOMINATIONS
NAME AND ADDRESS

CERTIFICATION
NUMBER

NAME AND TITLE (Type or print)

SIGNATURE

DATE

RETURN ORIGINAL OF THIS FORM AND THE ADVISORY COMMITTEE BACKGROUND INFORMATION FORM TO:

Marketing Programs Branch
Livestock and Seed Program, AMS
U.S. Department of Agriculture
1400 Independence Avenue, SW, Stop 0251, Room 2628-S
Washington, DC 20250-0251
LS-84 (02-11) (Destroy previous editions.)