Basic Information Form Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *EmailConfirm EmailCity, Country of Residence *AGE *(Required to identify generational composition of the MailinglLst's participants—for planning purposes, especially in the area of Jewish heritage education)Ancestral Surnames [Shtetls in Jewish Central Poland] / Approximate years if known. Please enter all your family surnames in our Jewish Central Poland area, for example: COHEN [Wloclawek, Lubraniec] / 1880?-1942 *Where did you hear about ADJCP?ADJCP Website Other Websites (please list below)Jewish Genealogy Database Sites eg. Jewishgen, JRI-P, IGRABlogs & Twitter Feed via Facebook, Twitter etc. ADJCP Shtetl Coordinators (please identify shtetl below)Existing SubscribersGeneral Word of MouthOther (please comment below)Additional Comments:EmailSubmit