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			<h1 class="article-header__title js-article-title js-page-title">Yizkor Booklet</h1>
		
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<form class="userform-form" action="" method="post" name="form_7400963" id="7400963" accept-charset="utf-8"><input type="hidden" name="formID" value="7400963" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_1"><div id="cid_1" class="form-input-wide"> <div style="text-align:center;"><img alt="" class="form-image" border="0" src="https://w3.chabad.org/media/images/1100/Omdc11000609.jpg" height="327" width="650" /></div> </div></li><li id="cid_30" class="form-input-wide"> <div class="form-header-group"><h3 id="header_30" class="form-header">Deadline for Yizkor booklet is Thursday, September 18th.</h3></div> </li><li class="form-line" id="id_40"><div class="form-label-left" id="label_40"><label for="input_40"> Name Only Dedication </label><label class="label-message" for="input_40"> Only the name will appear in the booklet. Please select how many names you would like to include</label></div><div id="cid_40" class="form-input"> <select class="form-dropdown" style="width:150px" id="input_40" name="q40_input40"><option value=""></option><option selected="selected" value="Please Select">Please Select</option><option value="1 Name: $36">1 Name: $36</option><option value="2 Names: $72">2 Names: $72</option><option value="3 Names: $108">3 Names: $108</option><option value="4 Names: $144">4 Names: $144</option><option value="5 Names: $180">5 Names: $180</option><option value="6 Names: $216">6 Names: $216</option><option value="7 Names: $252">7 Names: $252</option><option value="8 Names: $288">8 Names: $288</option><option value="9 Names: $324">9 Names: $324</option><option value="10 Names: $360">10 Names: $360</option></select> </div></li><li class="form-line" id="id_32"><div class="form-label-left" id="label_32"><label for="input_32"> Detailed Dedication </label><label class="label-message" for="input_32"> Please select size of dedication</label></div><div id="cid_32" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_32_0" name="q32_input32[]" value="1/3 Page: $180" /><label id="label_input_32_0" for="input_32_0"><span>1/3 Page: $180</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_32_1" name="q32_input32[]" value="1/2 Page: $360" /><label id="label_input_32_1" for="input_32_1"><span>1/2 Page: $360</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_32_2" name="q32_input32[]" value="Full Page: $613" /><label id="label_input_32_2" for="input_32_2"><span>Full Page: $613</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> DEDICATION 1: </label><label class="label-message" for="input_15"> If you selected "Name Only" , please list all the names you would like to include ($36/name)</label></div><div id="cid_15" class="form-input"> <textarea id="input_15" class="form-textarea" name="q15_dedication1" cols="65" rows="6"></textarea> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> DEDICATION 2: </label><label class="label-message" for="input_18"> If you selected a longer dedication, please submit your message here</label></div><div id="cid_18" class="form-input"> <textarea id="input_18" class="form-textarea" name="q18_dedication2" cols="65" rows="6"></textarea> </div></li><li class="form-line" id="id_27"><div class="form-label-left" id="label_27"><label for="input_27"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_27"> </label></div><div id="cid_27" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q27_fullName27[first]" id="first_27" autocomplete="given-name" />  <label class="form-sub-label" for="first_27" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q27_fullName27[last]" id="last_27" autocomplete="family-name" />  <label class="form-sub-label" for="last_27" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_28"><div class="form-label-left" id="label_28"><label for="input_28"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_28"> </label></div><div id="cid_28" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_28" name="q28_email28" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_41"><div class="form-label-left" id="label_41"><label for="input_41"> I would like to make an additional Yizkor donation in the amount of: </label><label class="label-message" for="input_41"> </label></div><div id="cid_41" class="form-input"> <div class="form-multiple-column" data-columns="3"><span class="form-radio-item"><input type="radio" class="form-radio" id="input_41_0" name="q41_input41" value="36" /><label for="input_41_0"><span>$36</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_41_1" name="q41_input41" value="72" /><label for="input_41_1"><span>$72</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_41_2" name="q41_input41" value="180" /><label for="input_41_2"><span>$180</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio" name="q41_input41" id="other_41" value="" /><span><input type="number" min="1" class="form-radio-other-input form-textbox" onkeypress="validateNumber(event)" name="q41_input41[other]" data-otherhint="Other" size="15" id="input_41" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_23"><div class="form-label-left" id="label_23"><label for="input_23"> Total </label></div><div id="cid_23" class="form-input"> <div id="total_amount">$0.00 </div><div class="form-single-column form-checkbox-item" id="div_offset_gift_23" style="padding-top: 10px">		<input type="checkbox" id="input_23" class="form-checkbox" name="q23_offsetGiftPercent" value="3" />		<label id="label_23" for="input_23">Yes, I'd like to donate the cost of processing this transaction by adding 3%</label>		<input type="hidden" id="hidden_23" name="q23_offsetGiftAmount" />		<div class="clearfix"></div>		</div> </div></li><li class="form-line" id="id_24"><div class="form-label-left" id="label_24"><label for="input_24"> Payment<span class="form-required">*</span> </label><label class="label-message" for="input_24"> </label></div><div id="cid_24" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"></td></tr><tr class="credit_card "><th colspan="2">Credit Card</th></tr><tr class="credit_card "><td colspan="2" style="padding:0"><table cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container">  <label class="form-sub-label">We accept Visa, MasterCard, American Express, Discover</label></span><div class="cc-icons"><div class="cc-icon visa-icon"></div><div class="cc-icon mastercard-icon"></div><div class="cc-icon amex-icon"></div><div class="cc-icon discover-icon"></div></div><input type="hidden" name="q24_payment24[cc_type]" id="input_24_cc_type" value="" /></td></tr><tr><td><div class="cc-field-wrapper"><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[required, visible, creditcard]" type="text" name="q24_payment24[cc_number]" id="input_24_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_24_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[required, visible]" type="text" name="q24_payment24[cc_ccv]" id="input_24_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_24_cc_ccv" id="sublabel_cc_ccv">Security Code</label></span></td></tr><tr><td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[required, visible]" type="text" name="q24_payment24[cc_nameOnCard]" id="input_24_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_24_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card "><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[required, visible]" name="q24_payment24[cc_exp_month]" id="input_24_cc_exp_month" autocomplete="cc-exp-month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_24_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select 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