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(UJ/JB if phone only, put [email protected] in the email field above)
(UJ/JB: All address fields required so we can assign to closest missionary)
Are they Jewish?*
Do they believe in Jesus?*
Contact Code*
Engagement Level*
Jewish Gentile Couple?
Contact indicated we may contact them by:

Explicit permission is required by GDPR.

Contact indicated we may save their belief and ethnicity information:

Explicit permission is required by GDPR.

Please be sure to include the link to the chat archive or full chat transcript below.
(ex: https://my.livechatinc.com/archives/P3KSEJV1L5)
Subscribe to Publications?*
IMPORTANT: Only choose to subscribe UJs to publications if they explicitly asked for Issues, otherwise do not select, we want the first point of contact to be from a missionary, not an automated email.

If yes for subscription, select which publications to subscribe them to:

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