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<form class="userform-form" action="" method="post" name="form_6698027" id="6698027" accept-charset="utf-8"><input type="hidden" name="formID" value="6698027" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_12"><div id="cid_12" class="form-input-wide"> <div style="text-align:center;"><img alt="" class="form-image" border="0" src="https://w2.chabad.org/media/images/951/dGnr9510610.png" height="291" width="745" /></div> </div></li><li class="form-line" id="id_3"><div id="cid_3" class="form-input-wide"> <div id="text_3" class="form-html"><h1 style="text-align: center;"><span style="color:#000000;"><span style="font-family:Copperplate,Copperplate Gothic Light,fantasy,serif;">Sponsor A Kiddush <br />
In honor of </span></span><br />
 </h1>

<h2 style="text-align: center;"><span style="font-family:Copperplate,Copperplate Gothic Light,fantasy,serif;">BAR/BAT MITZVAH - BIRTHDAY - ANNIVERSARY - YORTZIET - BABY KIDDUSH</span><br />
 </h2>

<h3 style="text-align: center;"><span style="font-family:Tahoma,Verdana,Segoe,sans-serif;">Come join us at The European Synagogue Ohel Eliezer for a<br />
delicious kiddush after services.</span></h3>

<hr />
<h1 style="text-align: center;"><br />
<span style="color:#000000;"><span style="font-size:26px;"><span style="font-family:TimesNewRoman,Times New Roman,Times,Baskerville,Georgia,serif;"><strong>Share your occasion with your family and friends at Shul!</strong></span></span></span><br />
 </h1>

<p style="text-align: center;"><span style="font-size:18px;"><span style="font-family:Tahoma,Verdana,Segoe,sans-serif;"><strong><span style="color:#2c3e50;">Lechayim Sponsor </span>|</strong><span style="color:#660000;"> <strong>€180</strong></span></span></span></p>

<p style="text-align: center;"><span style="font-size:18px;"><span style="font-family:Tahoma,Verdana,Segoe,sans-serif;"><strong><span style="color:#2c3e50;">Partial Kiddush Sponsor</span> |</strong> <span style="color:#660000;"><strong>€360</strong></span></span></span></p>

<p style="text-align: center;"><span style="font-size:18px;"><span style="font-family:Tahoma,Verdana,Segoe,sans-serif;"><strong><span style="color:#2c3e50;">Co Kiddush Sonsor </span>|</strong> <span style="color:#660000;"><strong>€500</strong></span></span></span></p>

<p style="text-align: center;"><span style="font-size:18px;"><span style="font-family:Tahoma,Verdana,Segoe,sans-serif;"><strong><span style="color:#2c3e50;">Full Kiddush Sponsor</span> | <span style="color:#330000;">€770</span></strong></span></span></p>

<p style="text-align: center;"><span style="color:#2c3e50;"><span style="font-size:18px;"><span style="font-family:Tahoma,Verdana,Segoe,sans-serif;"><strong>Birthday Cake | </strong></span></span></span><span style="color:#660000;"><span style="font-size:20px;"><strong>€75</strong></span></span></p>

<p style="text-align: center;"><span style="font-family:Palatino,Palatino Linotype,Palatino LT STD,Book Antiqua,Georgia,serif;"><span style="font-size:16px;">Co-sponsorship options are available.<br />
For holidays and special events,<br />
please call for more information.</span></span></p>

<hr />
<h1 style="text-align: center;"><br />
<span style="font-size:28px;"><span style="color:#660000;"><strong><span style="font-family:Tahoma,Verdana,Segoe,sans-serif;">Reserve Now Below!</span></strong></span></span><br />
 </h1>

<hr /></div> </div></li><li id="cid_13" class="form-input-wide"> <div class="form-header-group"><h3 id="header_13" class="form-header">Your Information:</h3></div> </li><li class="form-line" id="id_6"><div class="form-label-left" id="label_6"><label for="input_6"> Name<span class="form-required">*</span> </label><label class="label-message" for="input_6"> </label></div><div id="cid_6" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" name="q6_fullName[prefix]" size="4" id="prefix_6" autocomplete="honorific-prefix" />  <label class="form-sub-label" for="prefix_6" id="sublabel_prefix">Title</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q6_fullName[first]" id="first_6" autocomplete="given-name" />  <label class="form-sub-label" for="first_6" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q6_fullName[last]" id="last_6" autocomplete="family-name" />  <label class="form-sub-label" for="last_6" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_7" name="q7_email" size="30" value="" autocomplete="email" /> </div></li><li id="cid_22" class="form-input-wide"> <div class="form-header-group"><h3 id="header_22" class="form-header">Please Select:</h3></div> </li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> <span class="form-required">*</span> </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_9_0" name="q9_input9" value="Lechayim Sponsor" /><label id="label_input_9_0" for="input_9_0"><span>Lechayim Sponsor</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_9_1" name="q9_input9" value="Partial Kiddush Sponsor" /><label id="label_input_9_1" for="input_9_1"><span>Partial Kiddush Sponsor</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_9_2" name="q9_input9" value="Co Kiddush Sonsor" /><label id="label_input_9_2" for="input_9_2"><span>Co Kiddush Sonsor</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_9_3" name="q9_input9" value="Full Kiddush Sponsor" /><label id="label_input_9_3" for="input_9_3"><span>Full Kiddush Sponsor</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">  </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_15_0" name="q15_input15[]" value="Yes, I'd like a birthday cake!" /><label id="label_input_15_0" for="input_15_0"><span>Yes, I'd like a birthday cake!</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_20" class="form-input-wide"> <div class="form-header-group"><h3 id="header_20" class="form-header">Please choose week for sponsorship:</h3></div> </li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label 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id="sublabel_year">Year</label></span><span class="form-sub-label-container"><img class="showAutoCalendar" alt="Pick a Date" id="input_19_pick" src="https://w2.chabad.org/images/sitecontrol/formbuilder/calendar.png" align="absmiddle" />  <label class="form-sub-label" for="input_19_pick"><span> </span></label></span></div></div> </div></li><li id="cid_21" class="form-input-wide"> <div class="form-header-group"><h3 id="header_21" class="form-header">In Honor or Memory of:</h3></div> </li><li class="form-line" id="id_11"><div class="form-label-left" id="label_11"><label for="input_11"> <span class="form-required">*</span> </label><label class="label-message" for="input_11"> </label></div><div id="cid_11" class="form-input"> <textarea id="input_11" class="form-textarea validate[required]" name="q11_input11" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> Total </label></div><div id="cid_5" class="form-input"> <div id="total_amount">€0.00 EUR</div> </div></li><li class="form-line" id="id_4"><div class="form-label-left" id="label_4"><label for="input_4"> Payment<span class="form-required">*</span> </label><label class="label-message" for="input_4"> </label></div><div id="cid_4" 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"><span class="form-radio-item"><input class="paymentMethod form-radio validate[required, paymentMethod] form-radio" type="radio" id="input_4_creditCard" name="q4_payment[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_4_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[required, paymentMethod] form-radio" type="radio" id="input_4_other" name="q4_payment[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_4_other">Bank Transfer</label> </span></td></tr><tr class="credit_card hide"><th colspan="2">Credit Card</th></tr><tr class="credit_card hide"><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="q4_payment[cc_type]" id="input_4_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="q4_payment[cc_number]" id="input_4_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_4_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="q4_payment[cc_ccv]" id="input_4_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_4_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="q4_payment[cc_nameOnCard]" id="input_4_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_4_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card hide"><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[required, visible]" name="q4_payment[cc_exp_month]" id="input_4_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_4_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select class="form-textbox validate[required, visible]" name="q4_payment[cc_exp_year]" id="input_4_cc_exp_year" autocomplete="cc-exp-year"><option></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><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option></select>  <label class="form-sub-label" for="input_4_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="other hide"><td colspan="2">The European Synagogue account information:<br /><br />Belfius<br />BE83 0689 5082 1915<br />BIC GKCCBEBB<br /><br />Thank you! </td></tr></tbody></table> </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 style="display:none">Should be Empty: <input type="text" name="website" value="" /></li></ul></div><input type="hidden" id="simple_spc" 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