2021 ClearPro Rice Challenge Enrollment Form

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formId

Grower

First Name

Last Name

Farm Name

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Mobile Phone

Email Address

BASF or Horizon Ag Representative

Rep First Name

Rep Last Name

Consultant Company

Consultant Contact Infomation

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.

Varieties Planted	# of Acres Harvested	Total CWT	Average % Whole Grain	Average % Total Grain

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

Choose One:

City

State

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).

Jacket One

Jacket Two

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 15^th, 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 support my business. (Acceptance not required for entry into the contest.)

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