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ClearPro Rice Challenge Enrollment Form

BASF or Horizon Ag Representative

Please provide the following information related to your Clearfield or Provisia rice. REMEMBER TO SUBMIT YOUR MILL SHEET FOR THE QUALIFYING ACRES BY NOVEMBER 15, 2021. Entries that do not include the applicable mill sheet are not eligible for the contest.

Please provide the following information related to your Clearfield or Provisia rice.

Varieties Planted

# of Acres Harvested

Total CWT

Average % Whole Grain

Average % Total Grain

Upload Mill Settlement Form Herei Only PDF file type allowed

i All PDF files uploaded collectively, cannot exceed the size of 5 MB

i if you are unable to upload the mill settlement form, please email to ClearProRice@basf.com

We will use the following information for engraving onto applicable contest winners' custom board prize:

Certain contest winners will receive up to two jackets. indicate your jacket size(s). You can choose any combination of jacket styles (two Men's, one Men's and one Women's, or two Women's style jackets).

By submitting this Enrollment Form, I verify that:

I produced qualifying varieties of Clearfield or Provisia rice on at least 20 acres during 2021.

I will submit mill settlement sheets to verify yield and quality by November 15th, 2021.

I am a legal resident of AR, LA, MO, MS or TX, and I submit this form for potential entry into the contest and agree to the Official Contest Rules.

I Would like to receive emails from BASF with information that affects my crops, products, offers or services that can help supports my business.(Acceptane not required for entry into the contest.)

Publicity & Privacy Policy

Except where prohibited by law, each applicant hereby grants BASF and those acting on its behalf permission to use his/her name, voice, and/or likeness and any and all identifying characteristics including, but not limited to, the taking of photograph(s) and/or video(s) by or on behalf of BASF, for advertising and/or publicity purposes. Applicant further grants to BASF a royalty-free, worldwide, perpetual, irrevocable and assignable right to use such photograph(s) and/or video(s), including derivative works of same, in any and all media (including, but not limited to, websites, social media, press release, and printed publications and materials) now known or hereinafter invented. Applicant understands and acknowledge that specific categories of her/his Data may further be subject to the privacy Policy found at https://www.basf.com/us/en/legal/data-protection.html, which describes how personal information may be collected, processed, stored and used.

Notice Under California Consumer Privacy Act("CCPA")

Please be aware that by registering with BASF to learn more about products and services, downloading a mobile application, signing up for a platform or online service, making purchases, or initiating other business transactions or requests with BASF, BASF will be collecting certain personal information about you and your internet activity for specific business purposes. For a description of the information collected about you and the business purposes for which that information is used, please review BASF's Privacy Policy, which may be accessed here: https://www.basf.com/us/en/legal/data-protection.html
Summary
Rep First Name
Rep Last Name
Farm Name
Horizon or BASF Representative
Consultant Company
Varieties Planted # of Acres Harvested Total CWT Average % Whole Grain Average % Total Grain Upload Mill Settlement Form Here
City
State
Jacket One
Jacket Two