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Nomination Form

County Conservation District:_______________________________

_____________________________________________________

Name of Farm Operator:__________________________________

Farm Mailing Address:____________________________________

Telephone # (include area code): ____________________________

Number of Acres Farmed:
cropland ____________________ pasture __________________

Livestock (circle one): yes no
If yes, state number of each
Beef___________ Dairy___________
Poultry__________ Hogs____________
Veal:____________ Other (Specify):_____________________

Attach a narrative about the farm's nutrient management, soil, water, and other conservation practices, and include any photos. (Please label photos with what practice is being shown.)

Reminder: Nomination materials must be postmarked by
February 28, 2009.

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