Information Release Form
(Please print this form and complete it)

I have reviewed my test results and others that have been received and posted to the Stanley Surname DNA Project website. I agree to release the following personal information for publication on the Stanley Surname DNA Project website.

 
Please initial each of your choice(s) for release of information:

________		 You may publish the pedigree I submitted (living ancestors will be referred to as ("Living")
________ You may publish my E-mail 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 application (required) and Participant ID# (required)  
______________________________________________________
E-mail Address (required)
_______________________________________________________
Street Address (required) ---------------------- Apt. No.
_______________________________________________________
City/State/Zip (required)
_______________________________________________________
Country (required)
______________________________
Telephone Number
_________________________________ ______________
Signature                                                     Date

The required information will be compared with your application to verify your identity. Only those items initialed above will be published on the website.

Please complete this form and mail it to:

Richard D. Stanley
14077 Hamshire Rd
Hamshire, TX 77622