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			<h1 class="article-header__title js-article-title js-page-title">Community Seder RSVP</h1>
		
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<form class="userform-form" action="" method="post" name="form_6406522" id="6406522" accept-charset="utf-8"><input type="hidden" name="formID" value="6406522" /><div class="form-all dir_ltr" dir="ltr"><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="246" width="653" /> </div></li><li class="form-line" id="id_30"><div id="cid_30" class="form-input-wide"> <div id="text_30" class="form-html"><p>We are delighted to invite you to a community Seder held on Wednesday, April 1st.  Services will begin at 7:10 pm followed by the Seder. Chabad will also provide a "Seder in a Box" to friends in our area.<br />
<br />
<strong>Prior RSVP by Sunday, March 29th 12:00 pm necessary in order to attend the Seder. </strong></p>
</div> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q9_fullName9[first]" id="first_9" autocomplete="given-name" />  <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> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_10" name="q10_email10" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_12"><div class="form-label-left" id="label_12"><label for="input_12"> Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_12"> </label></div><div id="cid_12" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q12_phoneNumber12[area]" id="input_12_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <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></div> </div></li><li id="cid_26" class="form-input-wide"> <div class="form-header-group"><h3 id="header_26" class="form-header">Seder Selection:</h3></div> </li><li class="form-line" id="id_36"><div class="form-label-left" id="label_36"><label for="input_36"> In person </label><label class="label-message" for="input_36"> No charge, but donations are greatly appreciated</label></div><div id="cid_36" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_36_0" name="q36_input36[]" value="1st night, Wednesday Apirl 1st." /><label id="label_input_36_0" for="input_36_0"><span>1st night, Wednesday Apirl 1st.</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="q36_input36[other]" id="other_36" value="" /><span><input type="number" min="1" onkeypress="validateNumber(event)" class="form-checkbox-other-input form-textbox undefined" name="q36_input36[other][text]" data-otherhint="Amount" size="15" id="input_36" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_38"><div class="form-label-left" id="label_38"><label for="input_38"> Reservations for how many </label><label class="label-message" for="input_38"> </label></div><div id="cid_38" class="form-input"> <select class="form-dropdown" style="width:150px" id="input_38" name="q38_input38"><option value=""></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option></select> </div></li><li class="form-line" id="id_37"><div class="form-label-left" id="label_37"><label for="input_37"> Seder to Go </label><label class="label-message" for="input_37"> </label></div><div id="cid_37" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_37_0" name="q37_input37[]" value="For one person $54 (Includes one dinner any additional dinner is $25)" /><label id="label_input_37_0" for="input_37_0"><span>For one person $54 (Includes one dinner any additional dinner is $25)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_39"><div class="form-label-left" id="label_39"><label for="input_39"> How many additional meals?   </label><label class="label-message" for="input_39"> If more than 3 additional meals please call 607-797-0015)</label></div><div id="cid_39" class="form-input"> <select class="form-dropdown" style="width:150px" id="input_39" name="q39_input39"><option value=""></option><option value="1">1</option><option value="2">2</option><option value="3">3</option></select> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> Total Charge </label></div><div id="cid_5" class="form-input"> <div id="total_amount">$0.00 USD</div> </div></li><li class="form-line" id="id_1"><div class="form-label-left" id="label_1"><label for="input_1"> Payment Method </label><label class="label-message" for="input_1"> </label></div><div id="cid_1" 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[paymentMethod] form-radio" type="radio" id="input_1_creditCard" name="q1_paymentMethod[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_1_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_1_other" name="q1_paymentMethod[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_1_other">Venmo</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="q1_paymentMethod[cc_type]" id="input_1_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[visible, creditcard]" type="text" name="q1_paymentMethod[cc_number]" id="input_1_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_1_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[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></tr><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" />  <label class="form-sub-label" for="input_1_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[visible]" name="q1_paymentMethod[cc_exp_month]" id="input_1_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_1_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[visible]" name="q1_paymentMethod[cc_exp_year]" id="input_1_cc_exp_year" autocomplete="cc-exp-year"><option></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><option value="2035">2035</option></select>  <label class="form-sub-label" for="input_1_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">Venmo: Chabad-Binghamton<br />NOTE: Seder</td></tr></tbody></table> </div></li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> Comments? 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