*Your e-mail address:

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DENNY DNA SURNAME PROJECT

By submitting this information I agree to release the submitted personal

Please place a "YES" or "NO" in box for each item that you wish to have associated with your

information for publication on the Denny DNA Surname Project Website

(INFORMATION RELEASE FORM)

DNA test results. (You may elect not to release ANY information that would be associated to

you with your published DNA test results, if you so desire)

You may publish the pedigree that I will submit or have submitted for use

with my DNA test results (living ancestors will be shown as "LIVING" and

no vital information for them will be shown).*

You may publish my email address (shown below).*

You may publish my name.*

You may publish my mailing address (shown below).*

You may publish my phone number.*

Your full name (as it appears on your testing lab application).*

Participant ID# (if known).

Street Address*

Apt#

City*

State*

Zip*

Country*

Telephone Number*

DO NOT CHANGE

By submitting my preferences electronically, I hereby have indicated my preferences to share personal data with a "YES" or "NO" and wish to have this considered to be received just as if I had also manually initialed each box. NOTE: If you have printed out this data and are going to be mailing it (instead of submitting electronically), please initial each box, as well as indicating your YES/NO answer.

DATA IN THIS FIELD

DO NOT CHANGE

DO NOT CHANGE

*Your e-mail address: (AGAIN)

WebFormDesigner

                                                              NOTE
When you are filling in the boxes, do NOT use Tab Key to move between boxes, use the cursor.

YOUR EMAIL ADDRESS IS ASKED FOR TWICE TO INSURE IT IS ACCURATE. IT IS VERY IMPORTANT THAT WE HAVE YOUR CORRECT EMAIL OR THE SIGN UP PROCEDURE MAY NOT WORK.

Click this button to print out and submit the Information Release Form via postal mail.

This page last modified on Thursday, March 16, 2006

MAIL FORM TO

If your browser does not support Javascript and you cannot use the electronic submission of this form, you must use the PRINT INFORMATION RELEASE FORM button (below the form) to print it out. You should then complete & submit the paper form via postal mail to Bill Denney.