Nomination of Sorghum Producers for Appt. to Sorghum Bd.

REPRODUCE LOCALLY.

FORM APPROVED. - OMB NO. 0581-0093
U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

NOMINATION OF SORGHUM PRODUCERS FOR APPOINTMENT TO
THE SORGHUM PROMOTION, RESEARCH, AND INFORMATION BOARD
____________________________________________________________________________________________________________________________________

Pursuant to the Commodity Promotion, Research, and Information Act of 1996, the following names of sorghum producers
are submitted as nominees to the Sorghum Promotion, Research, and Information Board (Board) from the indicated State.

1. STATE/UNIT

__________________________________________________________________________________________________________________________________________________________

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

A. NAME AND ADDRESS OF ORGANIZATION/ASSOCIATION

C. NAME AND TITLE (PRINT OR TYPE)

D. EMAIL ADDRESS (name@provider.com)

B. FACSIMILE NO. AND AREA CODE

RETURN FORMS TO:

LPS (Rev. 04/17)

Research and Promotion Division
Livestock, Poultry, and Seed Program, AMS
U.S. Department of Agriculture
Street
City, State Zip
FAX: (202) 720-1125

E. SIGNATURE

DATE

See reverse for burden/non-discrimination statement

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