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	Seder RSVP - Chabad Lauderdale By The Sea
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<form class="userform-form" action="" method="post" name="form_5469381" id="5469381" accept-charset="utf-8">
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    <ul class="form-section">
      <li class="form-line" id="id_18">
        <div id="cid_18" class="form-input-wide">
          <img alt="" class="form-image" border="0" src="https://w2.chabad.org/media/images/948/Qvsk9480119.jpg" height="245" width="650" />
        </div>
      </li>
      <li class="form-line" id="id_27">
        <div id="cid_27" class="form-input-wide">
          <div id="text_27" class="form-html">
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            <p style="text-align: justify;"><span style="font-family: 'Palatino Linotype'; font-size: 22px;">Join us for a meaningful and enjoyable Passover Seder experience!
                <br />
                Relive the Exodus, discover the eternal meaning of the Haggadah, and enjoy a Passover Seder complete with hand-baked Shmurah Matzah, wine, and a wonderful dinner spiced with unique traditional customs. Experience the liberation and freedom of Passover and discover the Seder's relevance today.
                <br /></span><span style="font-family: 'Palatino Linotype';"><br /></span>
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            <label class="form-sub-label" for="first_9" id="sublabel_first"> First Name </label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q9_fullName9[last]" id="last_9" autocomplete="family-name" />
            <label class="form-sub-label" for="last_9" id="sublabel_last"> Last Name </label></span>
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            Phone Number<span class="form-required">*</span>
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              <label class="form-sub-label" for="input_12_area" id="sublabel_area"> Area Code </label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q12_phoneNumber12[phone]" id="input_12_phone" autocomplete="tel-local" size="8" />
              <label class="form-sub-label" for="input_12_phone" id="sublabel_phone"> Phone Number </label></span>
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        </div>
      </li>
      <li id="cid_26" class="form-input-wide">
        <div class="form-header-group">
          <h3 id="header_26" class="form-header">
            First Seder:
          </h3>
        </div>
      </li>
      <li class="form-line" id="id_14">
        <div class="form-label-left" id="label_14">
          <label for="input_14"> Adults </label>
          <label class="label-message" for="input_14">  </label>
        </div>
        <div id="cid_14" class="form-input"><span class="form-sub-label-container"><input type="number" class="form-number-input  form-textbox" id="input_14" name="q14_adults" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" />
            <label class="form-sub-label" for="input_14"> $75 per Adult/Seder </label></span>
        </div>
      </li>
      <li class="form-line" id="id_15">
        <div class="form-label-left" id="label_15">
          <label for="input_15"> Children </label>
          <label class="label-message" for="input_15">  </label>
        </div>
        <div id="cid_15" class="form-input"><span class="form-sub-label-container"><input type="number" class="form-number-input  form-textbox" id="input_15" name="q15_children" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" />
            <label class="form-sub-label" for="input_15"> $45 per Child/Seder </label></span>
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      </li>
      <li class="form-line" id="id_25">
        <div class="form-label-left" id="label_25">
          <label for="input_25"> I want to sponsor </label>
          <label class="label-message" for="input_25">  </label>
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        <div id="cid_25" class="form-input">
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          <div id="total_amount">
            $0.00 USD
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      </li>
      <li class="form-line" id="id_1">
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          <label for="input_1"> Payment Method </label>
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                Credit Card
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            </tr>
            <tr class="credit_card hide">
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                    <td colspan="2"><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q1_paymentMethod[cc_type]" id="input_1_cc_type" autocomplete="cc-type">
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                          <option value="Mastercard"> MasterCard </option>
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                          <option value="Discover"> Discover </option>
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                  <tr>
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                        <label class="form-sub-label" for="input_1_cc_number" id="sublabel_cc_number"> Credit Card Number </label></span>
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                    <td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q1_paymentMethod[cc_ccv]" id="input_1_cc_ccv" autocomplete="cc-csc" size="6" />
                        <label class="form-sub-label" for="input_1_cc_ccv" id="sublabel_cc_ccv"> Security Code </label></span>
                    </td>
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                  <tr>
                    <td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q1_paymentMethod[cc_nameOnCard]" id="input_1_cc_nameOnCard" autocomplete="cc-name" size="33" />
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                          <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>
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                          <option value="2022"> 2022 </option>
                          <option value="2023"> 2023 </option>
                          <option value="2024"> 2024 </option>
                          <option value="2025"> 2025 </option>
                          <option value="2026"> 2026 </option>
                          <option value="2027"> 2027 </option>
                          <option value="2028"> 2028 </option>
                          <option value="2029"> 2029 </option>
                          <option value="2030"> 2030 </option>
                          <option value="2031"> 2031 </option>
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                        <label class="form-sub-label" for="input_1_cc_exp_year" id="sublabel_cc_exp_year"> Expiration Year </label></span>
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            <tr class="other hide">
              <td colspan="2">
                Mail Check payable to Chabad
              </td>
            </tr>
          </tbody></table>
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      </li>
      <li class="form-line" id="id_17">
        <div class="form-label-left" id="label_17">
          <label for="input_17"> Comments? Questions? </label>
          <label class="label-message" for="input_17">  </label>
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          <textarea id="input_17" class="form-textarea" name="q17_commentsQuestions17" cols="40" rows="1"></textarea>
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          <div class="form-single-column form-checkbox-item">
            <input name="optin" value="true" type="checkbox" checked="checked" class="form-checkbox" id="input_19" />
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