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DNA Project


Information Release Form

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

You may publish the pedigree I submitted Yes No
(Living persons will be removed)

You may publish my E-mail address (shown below) Yes No

You may publish my name Yes No

You may publish my mailing address (shown below) Yes No

You may publish my phone number Yes No

You may release my name and email address to other participants of the DeLoach DNA Surname Project, but do not publish them on the website.Yes No

Your Full Name (include middle name)

E-mail Address (required)

Street Address (required)

City/State/Zip (required)

Country (required)

Telephone Number

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

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