Once my results are received as part of the Arnold DNA Study, I understand that my results will be posted on the Arnold DNA Study website using an individually assigned code, unless otherwise directed herein. I also agree to release the following personal information for publication on the Arnold DNA Study website.
My initials next to a statement will indicate my acceptance of that statement. This agreement has no expiration date and may be amended by me at any time by submitting a new agreement.
Note: Please initial the desired items.
________ You may publish my test results
________ You may publish my name
________ You may publish my e-mail address
________ You may publish my mailing address
________ You may publish my phone number
________ You may publish my ancestor list (living persons will be removed)
For administrative purposes, please provide all of the following information, even if it will not be published on the Arnold DNA Study website.
| _______________________________________________________ | _______________________________ |
| Participant's name, including middle name | FTDNA kit number |
| ____________________________________________________________________________ | |
| Participant's street address, including city, state/province/territory, zip/postal code and country | |
| ______________________________________________ | _______________________________ |
| Participant's e-mail address | Participant's telephone number |
| ______________________________________________ | _______________________________ |
| Participant's signature | Date |
|
Mail this signed form to: Dan Arnold, 1608 Mona Ave., Ocoee FL 34761, USA |
Rev. 02/07