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<title>
	Torah Dedication Form - Chabad of West Davie
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class="form-textbox validate[required, Numeric]" type="tel" name="q7_phoneNumber7[area]" id="input_7_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_7_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q7_phoneNumber7[phone]" id="input_7_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_7_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> Sponsor the writing of a special section: </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_0" name="q10_sponsorThe10[]" value="$10,000: Sefer (one of the five books of Moses)" /><label id="label_input_10_0" for="input_10_0"><span>$10,000: Sefer (one of the five books of Moses)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_1" name="q10_sponsorThe10[]" value="$5,000: Half a Sefer (one of the five books of Moses)" /><label id="label_input_10_1" for="input_10_1"><span>$5,000: Half a Sefer (one of the five books of Moses)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_2" name="q10_sponsorThe10[]" value="$2,500: A Quarter Sefer (one of the five books of Moses)" /><label id="label_input_10_2" for="input_10_2"><span>$2,500: A Quarter Sefer (one of the five books of Moses)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_3" name="q10_sponsorThe10[]" value="$1,800: The Ten Commandments" /><label id="label_input_10_3" for="input_10_3"><span>$1,800: The Ten Commandments</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_4" name="q10_sponsorThe10[]" value="$1,800: Bircat Kohanim (priestly blessing)" /><label id="label_input_10_4" for="input_10_4"><span>$1,800: Bircat Kohanim (priestly blessing)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_5" name="q10_sponsorThe10[]" value="$1,800: Shema Yisrael Prayer" /><label id="label_input_10_5" for="input_10_5"><span>$1,800: Shema Yisrael Prayer</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_6" name="q10_sponsorThe10[]" value="$1,800: Akeida (story of binding of Isaac)" /><label id="label_input_10_6" for="input_10_6"><span>$1,800: Akeida (story of binding of Isaac)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_7" name="q10_sponsorThe10[]" value="$1,800: Az Yashir (song at red-sea)" /><label id="label_input_10_7" for="input_10_7"><span>$1,800: Az Yashir (song at red-sea)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_8" name="q10_sponsorThe10[]" value="$1,800: Vayehi Binsoa (prayer at the ark opening)" /><label id="label_input_10_8" for="input_10_8"><span>$1,800: Vayehi Binsoa (prayer at the ark opening)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_9" name="q10_sponsorThe10[]" value="$1,800: Hashem Hashem (G-d’s attributes of mercy)" /><label id="label_input_10_9" for="input_10_9"><span>$1,800: Hashem Hashem (G-d’s attributes of mercy)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_10" name="q10_sponsorThe10[]" value="$1,800: Chazak (last verse of 1 of the 5 books)" /><label id="label_input_10_10" for="input_10_10"><span>$1,800: Chazak (last verse of 1 of the 5 books)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_11" name="q10_sponsorThe10[]" value="$1,800: Parsha (Torah portion of a week)" /><label id="label_input_10_11" for="input_10_11"><span>$1,800: Parsha (Torah portion of a week)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_12" name="q10_sponsorThe10[]" value="$360: Torah Verse" /><label id="label_input_10_12" for="input_10_12"><span>$360: Torah Verse</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_13" name="q10_sponsorThe10[]" value="$180: Word in the Torah" /><label id="label_input_10_13" for="input_10_13"><span>$180: Word in the Torah</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox-other form-checkbox validate[other]" name="q10_sponsorThe10[other]" id="other_10" value="" /><span><input type="text" form-checkbox="" class="form-checkbox-other-input form-textbox " name="q10_sponsorThe10[other][text]" data-otherhint="Other" size="15" id="input_10" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Letters in the torah </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <span class="form-sub-label-container"><input type="number" class="form-number-input  form-textbox" id="input_18" name="q18_lettersIn18" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" />  <label class="form-sub-label" for="input_18">$54/letter</label></span> </div></li><li class="form-line" id="id_21"><div id="cid_21" class="form-input-wide"> <div id="text_21" class="form-html"><p><span style="font-family: 'Palatino Linotype'; color: rgb(128, 0, 128);"><em><span style="font-size: 18px;"><strong>Sponsorship to adorn the Torah &amp; Shul</strong></span></em></span></p> <p><span style="font-family: 'Palatino Linotype';"><span style="color: rgb(128, 128, 0);"><strong>Silver Crown </strong></span><em>Dedicated in loving Memory of Mr. Berek Glucksberg</em></span></p><p><span style="font-family: 'Palatino Linotype';"><strong><span style="color: rgb(128, 128, 0);">Mantel</span></strong> (torah cover) <em>Dedicated in Honor of Reb Aizik and Rebetzin Schwei</em></span></p><p><span style="font-family: 'Palatino Linotype';"> <strong><span style="color: rgb(128, 128, 0);">Parochet</span></strong> (embroidered ark cover) <em>Dedecated in loving memory of Mr. Berek Glucksberg</em></span></p><p><span style="font-family: 'Palatino Linotype';"><strong><span style="color: rgb(128, 128, 0);">Silver Breastplate</span></strong> <em>Dedicated in the loving memory of the Chess &amp; Storm family </em></span></p><p><span style="font-family: 'Palatino Linotype';"><strong><span style="color: rgb(128, 128, 0);">Atzie Chaim</span></strong> (torah rollers) <em>Dedicated in loving memory of Mr. Barron</em></span></p><p><span style="font-family: 'Palatino Linotype';"><span style="color: rgb(128, 128, 0);"><strong>Yad</strong></span> (Pointer) <em>Dediacated by the Kochav family</em></span></p><p style="text-align: left;"><span style="font-family: 'Palatino Linotype'; font-size: 20px; color: rgb(128, 128, 0);"><em>                        ♦♦♦</em></span></p><p><span style="color: rgb(153, 51, 102);"><em><span style="font-family: 'Palatino Linotype'; color: rgb(153, 51, 102);"><em>Half of  the book <strong>Bereishit</strong> Reserved by Mr. Jay. Minsky</em></span></em></span></p></div> </div></li><li class="form-line" id="id_16"><div class="form-label-left" id="label_16"><label for="input_16"> Other amounts </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input"> <div class="form-single-column"><span class="form-radio-item simple-mode"><label id="label_input_16" for="input_16"><span>$</span></label><input type="text" class="form-textbox" id="input_16" name="q16_otherAmounts" value="" onkeypress="validateNumber(event)" /></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_12"><div class="form-label-left" id="label_12"><label for="input_12"> Total </label></div><div id="cid_12" class="form-input"> <div id="total_amount">$0.00 </div> </div></li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> In Honor/memory of </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input"> <textarea id="input_17" class="form-textarea" name="q17_inHonormemory" cols="35" rows="6"></textarea> </div></li><li class="form-line" id="id_15"><div id="cid_15" class="form-input-wide"> <div id="text_15" class="form-html"><p><em>Although PayPal has been selected for payment, you will be able to donate with your credit card.</em></p></div> </div></li><li class="form-line" id="id_8"><div class="form-label-left" id="label_8"><label for="input_8"> Payment<span class="form-required">*</span> </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" 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="paypal "><td colspan="2">Paypal has been selected. Payment will take place on the next page.</td></tr></tbody></table> </div></li><li class="form-line" id="id_6"><div class="form-label-left form-label-hidden" id="label_6"></div><div id="cid_6" class="form-input"> <div class="form-single-column form-checkbox-item"><input name="optin" value="true" type="checkbox" checked="checked" class="form-checkbox" id="input_6" /><label id="label_input_6" for="input_6">I would like to receive news and updates by email</label></div> </div></li><li class="form-line" id="id_2"><div id="cid_2" class="form-input-wide"> <div style="text-align: center; text-indent:156px;" class="form-buttons-wrapper button-align-auto"><button id="input_2" type="submit" class="form-submit-button  form-submit-button-none;">Submit</button></div> </div></li><li class="form-line" id="id_19"><div id="cid_19" class="form-input-wide"> <div id="text_19" class="form-html"><p style="text-align: center;">All those who purchase a word in the Torah, will have the merit to inscribe a letter in the Torah at the ceremony.</p></div> </div></li><li style="display:none">Should be Empty: <input type="text" name="website" value="" /></li></ul></div><input type="hidden" id="simple_spc" name="simple_spc" value="3400351" /><script type="text/javascript">document.getElementById("si"+"mple"+"_spc").value = "3400351-3400351";</script></form></div>
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