DNA Testing Application Form



Home Page†††††††††††††† DNA Analysis Page



Each Participant must send an Application and a Pedigree Chart to the George Surname project coordinator by E-Mail or regular mail. You may forward the application form by regular mail, as an attachment to your E-Mail, or just include the information on the form in your E-Mail. The signature block is used only for forms sent by regular mail. The Pedigree Chart should go back as far as possible on your male surname, but does not need to include information on any living person. Include as much information on the pedigree chart as possible. We do not have to publish the pedigree chart on the George Surname Study web site, itís your option.

E-Mail address:


Mailing address:

John L. George

7681 Clark Rd.

Hanover, MD 21076



I would like to participate in the George Surname Family Reconstruction Project. The project will provide anonymity and not publish my personal information. I agree to release certain information about my ancestors for publication on the George Surname web pages (see below). I understand that the results of this test will help determine whether or not the project participants are descended from a common male ancestor and that the overall test results may identify more than one family line with a common male ancestor for each line. Please refer to the DNA Analysis Page for more detailed instructions on joining the study. Family Tree DNA, the testing service, will enclose an invoice in the test kit. I will provide all payments directly to Family Tree DNA ($99 plus $2 shipping for the 12 marker test).

Please initial your choice(s) for release of information concerning the test results:



_____I wish to release only my project code number, ancestorís name, ancestorís chronology, ancestorís location, and DNA

††††††††††† markers (required)



______ You may publish the pedigree I submitted (optional)



Your Full Name (include middle name)--required

E-mail Address--required

Street Address (required) ---------------------- Apt. No.

City/State/Zip (required)

Country (required )

Telephone Number (required)

____________________________ ______________
Signature ---------------------------------- Date(For applications sent through the regular mail only)

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