Basic
| Username | |
| Sex | |
| Current Location (City, State) | new york |
| Birthplace (City, State) | new york |
| Birthdate | December 16, 1976 |
| Clinic/Bank/University/Doctor (USE COMMA BETWEEN MULTIPLE; SPELL FULL NAMES) | California Cryobank (CCB) – Reproductive Tissue Services |
| Donor ID (Alphanumeric Value ONLY! - NO EXTRA INFORMATION - Separate Multiple ID's with ',' - or 'N/A', 'Unknown', 'Anonymous') | 12179 |
| Known 'Donor' Information (or 'None') | na |
| I am a | |
| Searching For | |
| Known Genetic Health History (or 'None') | none |
| Age Discovered Donor Conception or Told Offspring | na |
| Social Parent(s) Type | |
| Month & Year I 'Donated' or Conceived (Parent or Offspring) | 3/2012 |
| Number of Naturally (non-DCP) Conceived Children ('zero' if none) | none |
| Number of 'Donor' Children ('zero' if none) | 3 |
| Number of Known 'Donor' Siblings ('zero' if none) | na |
| Registry Memberships | |
| DNA Database Memberships | I still need to submit my DNA to a database. |
| Paternal Haplogroup (or 'Unknown') | unknown |
| Maternal Haplogroup (or 'Unknown') | unknown |
| I MADE A MATCH! |
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