Application Form

BLAIR DNA PROJECT APPLICATION FORM
(For all BLAIRs and variant spellings)

I have read about the BLAIR DNA Project which is described on the website located at http://blairsociety.org/dna/ and I would like to participate. I understand that the results of this test will help determine whether or not the project participants are descended from a common ancestor, and I understand that a specific ancestor will not be targeted. Since the BLAIR name is so widely used, there will be more than one family line identified.

Please enter the personal information below EXACTLY the way the shipping label and certificate should be printed.

Do NOT enter any web addresses (urls) into this form or the form will be REJECTED

First Name	(required)
Middle Name
Last Name	(required)
Address1	(required)
Address2
City	(required)
State or Other	(required)
Postal Code	(required)
Country	(required)
Phone - Fax	(xxx) xxx-xxxx
Email	(required)
Type of Test
Would you like to Subscribe to the Family Tree DNA Email Newsletter?

Please read the Participation Agreement below and check each block. Orders will NOT be placed unless ALL boxes are checked.

Participation Agreement Yes, I want to sign up and I am willing to pay for the analysis of my DNA sample. Family Tree DNA has given a new special price of $99.00 + p/h for the Y-DNA12 Marker test, $148.00 + p/h for the Y-DNA25 Marker test, $189.00 + p/h for the Y-DNA37 Marker test or $269.00 +p/h for the Y-DNA67 Marker test. I am enclosing my completed Pedigree Chart, which contains my male BLAIR line back to my earliest known BLAIR ancestor. (If you can trace your ancestor back farther than your great great grandfather, please use two sheets). I have included dates and places of birth when known, where they resided and the name of spouse, to enable you to match potential family lines. THE PEDIGREE CHART IS REQUIRED. I agree to release my project code number, ancestor's name, ancestor's chronology, ancestor's location, and DNA markers for publication on the BLAIR DNA Project web pages. No information concerning my identity may be published or released without my written permission. I have read the Release of Liability/Liability Waiver and agree that by participating in this project I am releasing both blairgenealogy.com and the BLAIR DNA Project Family Coordinator (John A. Blair) of any legal issue which may arise out of my participation. This includes but is not limited to emotional impacts from an unanticipated DNA sequence result, samples being lost in transit, and poor samples being provided.

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