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CONWAY/CONAWAY/CONNAWAY or HANNA/HANNAH/HANNON Surname DNA Project Information Release Form
By participation in the project, I agree to release the following personal information for publication on the
Conway/Conaway/Connaway Surname DNA Project website at http://pages.prodigy.net/blankenstein/new_page_3.htm
(Please initial each of your choice(s) for release of information):
________ You may publish my Y-chromosome DNA results
________ You may publish the pedigree I submitted (Living persons will be removed)
________ You may publish my E-mail address (shown below)
________ You may publish my name
_____________________________________________
Participant's Full Name (include middle name) (required)
__________________________________________________
Participant Kit ID# (required)
_____________________________________________
Street Address (required)
_____________________________________________
City/State/Zip/Country (required)
_____________________________________________
Sponsor's Name (if applicable)
_____________________________________________
Contact E-mail Address (required)
_____________________________________________
Contact Telephone Number
_______________________________________________________________
Signature (Participant or Sponsor) Date
Only those items indicated above will be published on the website.
Please either e-mail the information or print, complete, and mail this form to:
Dianne Blankenstein
3732 Cork Place
Fort Worth, Texas 76116
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