LPS-45-R Soybean Nomination Form

FORM APPROVED - OMB NO. 0581-0093

REPRODUCE LOCALLY. Include form number on all reproductions.
U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

NOMINATION OF SOYBEAN PRODUCERS FOR APPOINTMENT TO THE UNITED SOYBEAN BOARD
___________________________________________________________________________________________________________________________________________________

1. STATE/UNIT

Pursuant to the Soybean Promotion, Research, and Consumer Information Act, the following names of soybean
producers are submitted as nominees to the United Soybean Board (Board) as representatives of the indicated
state.
_____________________________________________________________________________________________________________________

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 BACKGROUND
INFORMATION SHEET SIGNED BY EACH NOMINEE MUST BE ATTACHED.

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

NAME AND TITLE (PRINT OR TYPE)

EMAIL ADDRESS ([email protected])

FACSIMILE NO. AND AREA CODE

RETURN FORMS TO: Research and Promotion Division
Livestock, Poultry, and Seed Program, AMS
U.S. Department of Agriculture
Street
City, State Zip
LPS-45-R (Rev. 04/17)

DATE

SIGNATURE

FAX - (202) 720-1125

See reverse for burden/non-discrimination statement

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