Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you farming on heir's property *

Yes

No

Are you an organic farmer? *

Yes

No

Do you have past experience growing rice? *

Yes

No

Do you plan on retiring from farming in the next few years? *

Yes

No

Are you a Pigford claimant? *

Yes

No