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<p class="HeaderTitle">Chabad Hebrew School</p>

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Inspiring Jewish Pride and Identity in Jewish Children - the future of Judaism.
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      <p class="SectionTitle_Green">Support</p>
<p>Chabad Hebrew School of (your town) has a policy to accept all children regardless of their family's financial standing.  You can help by sponsoring a child.  Your generous contribution will help enable local children from our community to receive the Jewish education that they so rightly deserve.  Thank you for your support.</p>
<p>Please use the form below to contribute to our Scholarship Fund:</p>
<p>I want to make a contribution of: $ <input class="light" style="text-align: right" tabindex="1" size="7" required="false" name="Amount" type="text">  US<img height="5" alt="" width="1" src="http://template.centers.chabad.org/images/global/spacer.gif">
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                      <div align="center"><em>Optional</em></div>
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<input tabindex="2" type="radio" name="support_reason" value="memory"> <strong>In Memory of</strong>
<br>
 Make a donation in memory of a deceased family member or friend.
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 <img height="6" alt="" width="1" src="http://template.centers.chabad.org/images/global/spacer.gif">
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 <input tabindex="3" type="radio" name="support_reason" value="honor"> <strong>In Honor of</strong>
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 Make a donation in honor of someone or to celebrate a joyous occasion.
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 Details:
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 <textarea class="light" style="width: 443px; height: 80px" tabindex="4" rows="3" cols="51" required="false" name="support_reason_Details"></textarea></font>
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<p><br>
<span style="color: #ff0000"><strong>*</strong></span> Denotes required field
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<table class="covertype" id="table11" cellspacing="0" cellpadding="6" width="439" border="0">
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            <td valign="top" width="121" height="13">Title<span style="color: #ff0000">*</span></td>
            <td valign="top" width="290" height="13"><select class="light" tabindex="5" size="1" name="title"><option value="0" selected></option>
                <option value="Chaplain">Chaplain</option>
                <option value="Dr.">Dr.</option>
                <option value="Dr. &amp; Mrs.">Dr. &amp; Mrs.</option>
                <option value="Drs.">Drs.</option>
                <option value="Mr.">Mr.</option>
                <option value="Mrs.">Mrs.</option>
                <option value="Ms.">Ms.</option>
                <option value="Mr. &amp; Mrs.">Mr. &amp; Mrs.</option>
                <option value="Rabbi">Rabbi</option>
                <option value="Rabbi &amp; Mrs.">Rabbi &amp; Mrs.</option>
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            <td valign="top" width="121" height="6">Last Name<font color="#ff0000">*</font>
            </td>
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            <td valign="middle" width="121" height="47">Address Line 1<span style="color: #ff0000">*</span></td>
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            <td valign="middle" width="121" height="21">Address Line 2</td>
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            <td valign="middle" width="121" height="12">City<span style="color: #ff0000">*</span></td>
            <td valign="middle" width="290" height="12"><input class="light" tabindex="10" required="true" name="City" type="text"></td>
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<tr>
            <td valign="middle" width="121" height="13">State</td>
            <td valign="middle" width="290" height="13"><input class="light" tabindex="11" size="10" required="false" name="State" type="text"></td>
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<tr>
            <td valign="middle" width="121" height="12">Post Code<span style="color: #ff0000">*</span></td>
            <td valign="middle" width="290" height="12"><input class="light" tabindex="12" size="10" required="true" name="Post Code" type="text"></td>
          </tr>
<tr>
            <td valign="middle" width="121" height="13">Country<font color="#ff0000">*</font>
            </td>
            <td valign="middle" width="290" height="13"><input class="light" tabindex="13" required="false" name="Country" value="USA" type="text"> <!--<SELECT class=light
      name=Country>
      <OPTION value=" "
      selected>
      <OPTION>Mr.</OPTION>
      <OPTION>Mrs.</OPTION>
      <OPTION>Mr. &amp; Mrs.</OPTION>
      <OPTION>Dr.</OPTION>
      <OPTION>Dr. and Mrs.</OPTION>
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          </tr>
<tr>
            <td valign="middle" width="121" height="13">Phone</td>
            <td valign="middle" width="290" height="13"><input class="light" tabindex="14" required="false" name="Phone" type="text"></td>
          </tr>
<tr>
            <td valign="top" width="425" colspan="2" height="21">This is my <input tabindex="15" type="radio" name="AddressType" value="home"> home <input tabindex="16" type="radio" name="AddressType" value="business"> business address.</td>
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<p><br>
 </p>
<table class="covertype" id="table12" cellspacing="0" cellpadding="6" width="441" border="0">
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            <td valign="top" width="122" height="21">Card Type<span style="color: #ff0000">*</span></td>
            <td valign="top" width="291" height="21"><select class="light" tabindex="17" size="1" name="CCType"><option value="0" selected></option>
                <option value="Visa">Visa</option>
                <option value="Master Card">Master Card</option>
                <option value="American Express">American Express</option>
                <option value="Discover">Discover</option>
                <option value="Diners Club">Diners Club</option></select></td>
          </tr>
<tr>
            <td valign="top" width="122" height="21">Card Number<span style="color: #ff0000">*</span></td>
            <td valign="top" width="291" height="21"><input class="light" tabindex="18" required="true" name="CCDNum" type="text"></td>
          </tr>
<tr>
            <td valign="top" width="122" height="21">Expiration Date<span style="color: #ff0000">*</span></td>
            <td valign="top" width="291" height="21"><select class="light" tabindex="19" size="1" name="CCMonth"><option value="01" selected>01</option>
                <option value="02">02</option>
                <option value="03">03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option></select> <select class="light" tabindex="20" name="CCYear"><option value="2009" selected>2009</option>
                <option value="2010">2010</option>
                <option value="2011">2011</option>
                <option value="2012">2012</option>
                <option value="2013">2013</option>
                <option value="2014">2014</option>
                <option value="2015">2015</option>
                <option value="2016">2016</option></select></td>
          </tr>
<tr>
            <td valign="top" width="427" colspan="2" height="21">CVV Security Code <input class="light" tabindex="21" size="4" required="true" name="CVV" type="text"></td>
          </tr>
        </tbody>
      </table>
<p><br>
 </p>
<table class="covertype" id="table13" cellspacing="0" cellpadding="6" width="442" border="0">
        <tbody>
          <tr>
            <td valign="top" width="428" colspan="2" height="21"><strong>Acknowledgement</strong></td>
          </tr>
<tr>
            <td valign="top" width="166" height="21">Email Address<font color="#ff0000">*</font>
            </td>
            <td valign="top" width="248" height="21"><input class="light" tabindex="22" size="32" required="true" name="Email" type="text"></td>
          </tr>
<tr>
            <td valign="top" width="166" height="21">Reconfirm Email Address<span style="color: #ff0000">*</span></td>
            <td valign="top" width="248" height="21"><input class="light" tabindex="23" size="32" required="true" name="Email_Confirmation" type="text"></td>
          </tr>
<tr bgcolor="#F4F4F4">
            <td valign="top" width="428" colspan="2" height="22"><strong> Recurring donation:
<br></strong> <input tabindex="27" type="checkbox" name="Recurring" value="Yes"> Please charge the above amount to my credit card each month for the next twelve months.</td>
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