Nominee Agreement to Serve

National Sheep Industry Improvement Center

Nominee Agreement to Serve OMB 0581-NEW

National Sheep Center--Nominations

OMB: 0581-0263

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Form Approved O.M.B No. 0581-NEW

NOMINEE’S AGREEMENT TO SERVE

If appointed, I agree to serve on the National Sheep Industry Improvement Center
Board (Board), and to disclose to the Secretary of Agriculture any relationship
with any sheep and/or goat promotion entity or any organization that has a
contractual relationship with the Board.

___________________
Date

_______________________
Signature

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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.


File Typeapplication/pdf
AuthorMichelle Ohrvall
File Modified2010-07-15
File Created2010-07-15

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