Basic
| Username | |
| Sex | |
| Current Location (City, State) | Kenosha, WI |
| Birthplace (City, State) | Kenosha, WI |
| Birthdate | September 4, 1957 |
| Clinic/Bank/University/Doctor (USE COMMA BETWEEN MULTIPLE; SPELL FULL NAMES) | Zygen Laboratory |
| Donor ID (Alphanumeric Value ONLY! - NO EXTRA INFORMATION - Separate Multiple ID's with ',' - or 'N/A', 'Unknown', 'Anonymous') | NA |
| Known 'Donor' Information (or 'None') | None |
| I am a | |
| Searching For | |
| Known Genetic Health History (or 'None') | No medical problems |
| Age Discovered Donor Conception or Told Offspring | N/A |
| Social Parent(s) Type | |
| Month & Year I 'Donated' or Conceived (Parent or Offspring) | 1981-1990 |
| Number of Naturally (non-DCP) Conceived Children ('zero' if none) | 2 |
| Number of 'Donor' Children ('zero' if none) | N/A |
| Number of Known 'Donor' Siblings ('zero' if none) | N/A |
| Registry Memberships | |
| DNA Database Memberships | |
| Paternal Haplogroup (or 'Unknown') | Unknown |
| Maternal Haplogroup (or 'Unknown') | Unknown |
| I MADE A MATCH! |
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