Independent Board Member Application
To submit your name for consideration as an Independent Board Member, please complete all questions. Please note, under ADA North East, Inc. policy set by the Board of Directors, in order to qualify as a board member on the ADA North East, Inc. board, a member must contribute $.10 to promotion through ADA North East unless they are a member of another generic promotion board and then the minimum payment is $.05 to ADA North East, Inc.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Cellular Number
*
Format: (000) 000-0000.
Where is your milk shipped to:
*
Milk Handler contact phone number for verification:
*
Please let us know why you would like to be considered to serve on the American Dairy Association North East Board of Directors:
*
Signature
*
Signature Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Completed applications must be submitted by 11:59 p.m. on November 13, 2026.
Apply for Consideration
Should be Empty: