Ivey-Ivie-Ivy Surname DNA Project
Application Form
I have read about the Ivey-Ivie-Ivy Surname DNA Project described at
http://www.jlivey.net/dna or
http://www.jlivey.com/dna,
and would like to participate.
By participating in this project, I jointly and severally forever release and
discharge Jerry L Ivey from any and all
claims, liabilities, judgments, and proceedings, both at law and in equity,
arising from my participation in the Ivey-Ivie-Ivy SURNAME DNA PROJECT. This release
shall be binding upon and inure to the benefit of the parties, their successors,
assigns and personal representatives.
_____________________________________________
Participant's Full Name
_____________________________________________
Sponsor's Name, if other than Participant
_____________________________________________
Contact E-mail Address
_____________________________________________
Street Address
_____________________________________________
City/State/Zip
_____________________________________________
Country
_____________________________________________
Telephone Number
Choose One: _____ 12 marker test ($99.00 plus $2.00 s/h)
_____ 25 marker test ($124.00 plus $2.00 s/h)
_____ 37 marker test ($149.00 plus $2.00 s/h)
_____ 67 marker test ($238.00 plus $2.00 s/h)
_____ 111 marker test ($339.00 plus $2.00 s/h)
_____________________________________________________________
Signature of Participant
Date
_____________________________________________________________
Signature of Sponsor (if applicable) Date
*** Please include a brief pedigree showing your paternal lineage from earliest known Ivey-Ivie-Ivy ancestor.
*** Please include signed Information Release Form. (Optional and may be rescinded at any time)
*** Please do NOT include payment with this application.
Return to:
Jerry L Ivey
800 E. 15th Street, #210
Plano, TX 75074