MAN-NOM Mangos Nomination Form - English

Approved - OMB No. 0581-0093

NATIONAL MANGO BOARD
NOMINATION TO SERVE ON THE NATIONAL MANGO BOARD (Under the Mango Promotion, Research, and Information Order (7 CFR Part 1206))
The Mango Promotion, Research, and Information Order provides that importers, first handlers, domestic producers, and foreign producer organizations may submit nominees to serve on the National Mango Board. Nominees for first handlers and domestic producers may be submitted by respective entities; importers may submit nominees for their respective region(s); and eligible foreign producer organizations may submit nominees for foreign producer positions. Attach a separate sheet if additional space is needed. Please submit a separate form for each nominee.
NAME, BUSINESS ADDRESS, AND TELEPHONE NUMBER OF NOMINEE	CHECK ONE
		( ) DOMESTIC PRODUCER Domestic Producer means any person who is engaged in the production and sale of mangos in the United States and who owns, or shares the ownership and risk of loss of, the crop or a person who is engaged in the business of producing, or causing to be produced, mangos beyond the person’s own family use and having value at first point of sale. ( ) FIRST HANDLER First Handler means any person, (excluding a common or contract carrier), receiving 500,000 or more pounds of mangos from producers in a calendar year and who as owner, agent, or otherwise ships or causes mangos to be shipped as specified in the Order. This definition includes those engaged in the business of buying, selling and/or offering for sale; receiving; packing; grading; marketing; or distributing mangos in commercial quantities. The term first handler includes a producer who handles or markets mangos of the producer’s own production. ( ) IMPORTER Importer means any person importing 500,000 or more pounds of mangos into the United States in a calendar year as a principal or as an agent, broker, or consignee of any person who produces or handles mangos outside of the United States for sale in the United States, and who is listed as the importer of record for such mangos. ( ) FOREIGN PRODUCER Foreign Producer means any person: Who is engaged in the production and sale of mangos outside of the United States and who owns, or shares the ownership and risk of loss of the crop for sale in the U.S. market; or Who is engaged, outside of the United States, in the business of producing, or causing to be produced, mangos beyond the person’s own family use and having value at first point of sale.
NAME AND MAILING ADDRESS OF PARTY OR ELIGIBLE ORGANIZATION SUBMITTING NOMINATION
NAME OF RESPONDING OFFICIAL (PRINT)	SIGNATURE
TITLE OF RESPONDING OFFICIAL (PRINT)	DATE
RETURN ORIGINAL TO: NATIONAL MANGO BOARD Street City, State, Zip Telephone No. (XXX) XXX-XXXX

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 minute 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.



In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: 1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW., Washington, D.C. 20250-9410; 2) fax: (202) 690-7442; or 3) email: [email protected].

USDA is an equal opportunity provider, employer, and lender.

MAN-NOM (English) (Expiration Date XX/XX/20XX) See reverse for burden/non-discrimination statement