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	Kol Nidrei & Yizkor Appeal - Chabad of Port Washington
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<h5>Holiday Date</h5>    
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October 1 - 11, 2027</div></div>
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			<h1 class="article-header__title js-article-title js-page-title">Kol Nidrei & Yizkor Appeal</h1>
		
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      <p>Increase your generosity of Tzedakah (charity) on the High Holidays during our  <br>
Kol Nidrei / Yizkor Appeal.</p>
<p> </p>
<table width="100%" class="covertype" bgcolor="ebf2fe" border="0" cellspacing="0" cellpadding="5" align="center" dir="ltr" style="">
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<tr style="font-family: Arial; font-size: 10px;">
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                <font size="2"><strong>Kol Nidrei / Yizkor Pledge</strong>
<br>
<img width="1" height="6" alt="" src="https://w2.chabad.org/images/global/spacer.gif"><br>
            Make a donation in <strong>memory of</strong> a deceased family member or friend.  <br>
<br>
            Please accept my donation in memory of my: (relationship)</font>
<input tabindex="1" required="false" type="text" size="18" style="width: 151px; height: 22px;" name="relationship">
<font size="2"><br>
<br>
            Name of deceased:               </font>
<input tabindex="1" required="false" type="text" size="18" style="width: 152px; height: 22px;" name="name of deceased">
<font size="2"><br>
<br>
            Hebrew name of deceased:  </font>
<input tabindex="1" required="false" type="text" size="17" style="width: 153px; height: 22px;" name="hebrew name of deceased">
<font size="2">
<br>
<br>
            Father's name of deceased:  </font>
<input tabindex="1" required="false" type="text" size="19" style="width: 153px; height: 22px;" name="fathers name of deceased"></font>
<font face="Tahoma" size="2">
<img width="1" height="6" alt="" src="https://w2.chabad.org/images/global/spacer.gif"></font>
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<font face="Tahoma"><br>
<br>
<font size="2">Details: <br>
</font>
                </font><textarea tabindex="2" class="light" required="false" rows="3" cols="36" name="Details">Please specify details, if             any.</textarea></font>
            </td>
</tr>
<tr>
<td bgcolor="#ffffff"> </td>
</tr>
<tr>
<td bgcolor="#ffffff">
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<tbody>
<tr>
<td bgcolor="#e4f0f0" colspan="3">
<strong>
<font face="Tahoma">SUGGESTED DONATIONS</font></strong></td>
</tr>
<tr>
<td>
<font face="Tahoma"><input tabindex="3" type="radio" value="10,000" name="donate">  $10,000 - Patron of Chabad</font>
                    </td>
<td>
<font face="Tahoma"><input tabindex="5" type="radio" value="1,800" name="donate">  $1,800 - Sponsor JLI Course</font>
                    </td>
<td>
<font face="Tahoma"><input tabindex="7" type="radio" value="360" name="donate">  $360 -Partial Hebrew School Scholarship</font>
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</tr>
<tr>
<td>
<font face="Tahoma"><input tabindex="4" type="radio" value="7,200" name="donate">  $7,200 - Full Day School Scholarship</font>
                    </td>
<td>
<font face="Tahoma"><input tabindex="6" type="radio" value="1,000" name="donate">  $1,000 - Sponsor Adult Education Series</font>
                    </td>
<td>
<font face="Tahoma"><input tabindex="8" type="radio" value="180" name="donate">  $180 - Chai Donor</font>
                    </td>
</tr>
<tr>
<td>
<font face="Tahoma"><input tabindex="4" type="radio" value="3,600" name="donate">  $3,600 - Partial Day School Scholarship</font>
                    </td>
<td>
<font face="Tahoma"><input tabindex="6" type="radio" value="720" name="donate">  $720 - Hebrew School Scholarship</font>
                    </td>
<td>
                      <font face="Tahoma"><input tabindex="9" type="radio" value="other" name="donate">  Other: $</font>
<input tabindex="9" required="false" type="text" size="8" value=".00" style="width: 64px; height: 22px;" name="Other Amount"></td>
</tr>
<tr>
<td>
<p>
<font face="Tahoma"><input tabindex="5" type="radio" value="2,200" name="donate">  $2,200 - Summer Day Camp Scholarship</font>
                      </p>
</td>
<td> </td>
<td> </td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td bgcolor="#ffffff">
              <font face="Tahoma"><strong>Membership:</strong>
<br>
<input tabindex="10" type="checkbox" value="on" name="Count me in as member">  Count me in as a member of Chabad of Port Washington!</font>
<br>
<font face="Tahoma" size="1">I understand first year membership is discounted by 50% to $750 Family; $450 Single Parent Family; $375 Single</font>
            </td>
</tr>
<tr>
<td bgcolor="#ffffff">
<table width="100%" dir="ltr" border="0" cellspacing="0" cellpadding="2" style="font-family: Arial; font-size: 10pt; border-collapse: collapse;">
<tbody>
<tr>
<td height="15" bgcolor="#e4f0f0">
<strong>
<font face="Tahoma">OPTIONAL: ALLOCATION OF FUNDS</font></strong></td>
</tr>
<tr>
<td width="50%" height="15" bgcolor="#ffffff">
<font face="Tahoma"><input tabindex="11" type="checkbox" value="Yes" name="General Operating Fund"> General Operating Fund <br>
<input tabindex="11" type="checkbox" value="Yes" name="Mikvah Fund"> Mikvah Fund <br>
<input tabindex="12" type="checkbox" value="Yes" name="Hebrew School"> Hebrew School Scholarship Fund <br>
<input tabindex="13" type="checkbox" value="Yes" name="Building Bridges Fund"> Building Bridges Fund <br>
<input tabindex="14" type="checkbox" value="Yes" name="Rabbis Dicretionary Fund"> Rabbi's Discretionary Fund</font>
                    </td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
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<td width="591" height="13" valign="top" bgcolor="#e4f0f0" colspan="5">
<font color="#000000" face="Tahoma">
<strong>Personal Information</strong></font>
            </td>
</tr>
<tr>
<td width="591" height="13" valign="top" colspan="5">
<font face="Tahoma">
                <font color="#ff0000">
<strong>*</strong></font> Denotes required field</font>
            </td>
</tr>
<tr>
<td width="111" height="13" valign="top">
<font face="Tahoma">Title<font color="#ff0000">*</font>
              </font>
            </td>
<td width="163" valign="top">
<select tabindex="15" class="light" name="title">
<option selected value="0"></option>
<option value="Chaplain">Chaplain</option>
<option value="Dr.">Dr.</option>
<option value="Dr. &amp;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;amp; Mrs.">Mr. &amp; Mrs.</option>
<option value="Rabbi">Rabbi</option>
<option value="Rabbi &amp;amp; Mrs.">Rabbi &amp; Mrs.</option>
<option value="The Honorable">The Honorable</option>
</select></td>
<td width="42" valign="top"> </td>
<td width="91" valign="top">
<font face="Tahoma">City<font color="#ff0000">*</font>
              </font>
            </td>
<td width="184" height="13" valign="top">
<input tabindex="20" class="light" required="true" type="text" name="x_city"></td>
</tr>
<tr>
<td width="111" height="6" valign="top">
<font face="Tahoma">First Name<font color="#ff0000">*</font>
              </font>
            </td>
<td width="163" valign="top">
<input tabindex="16" class="light" required="true" type="text" name="x_first_name"></td>
<td width="42" valign="top"> </td>
<td width="91" valign="top">
<font face="Tahoma">State</font>
            </td>
<td width="184" height="6" valign="top">
<input tabindex="21" class="light" required="true" type="text" size="10" name="x_state"></td>
</tr>
<tr>
<td width="111" height="6" valign="top">
<font face="Tahoma">Last Name<font color="#ff0000">*</font>
              </font>
            </td>
<td width="163" valign="top">
<input tabindex="17" class="light" required="true" type="text" name="x_last_name"></td>
<td width="42" valign="top"> </td>
<td width="91" valign="top">
<font face="Tahoma">Post Code<font color="#ff0000">*</font>
              </font>
            </td>
<td width="184" height="6" valign="top">
<input tabindex="22" class="light" required="true" type="text" size="10" name="x_zip"></td>
</tr>
<tr>
<td width="111" height="34" valign="middle">
<font face="Tahoma">Address Line 1<font color="#ff0000">*</font>
              </font>
            </td>
<td width="163" valign="middle">
<input tabindex="18" class="light" required="true" type="text" name="x_address"></td>
<td width="42" valign="middle"> </td>
<td width="91" valign="middle">
<font face="Tahoma">Country<font color="#ff0000">*</font>
              </font>
            </td>
<td width="184" height="34" valign="middle">
<font color="#ff0000">
<input tabindex="23" class="light" required="true" type="text" value="USA" name="x_Country"></font>
            </td>
</tr>
<tr>
<td width="111" height="21" valign="middle">
<font face="Tahoma">Address Line 2</font>
            </td>
<td width="163" valign="middle">
<input tabindex="19" class="light" required="false" type="text" name="Address2"></td>
<td width="42" valign="middle"> </td>
<td width="91" valign="middle">
<font face="Tahoma">Phone<font color="#ff0000">*</font>
              </font>
            </td>
<td width="184" height="21" valign="middle">
<input tabindex="24" class="light" required="true" type="text" name="x_Phone"></td>
</tr>
<tr>
<td width="111" height="12" valign="middle"> </td>
<td width="163" valign="middle"> </td>
<td width="42" valign="middle"> </td>
<td width="275" height="12" valign="middle" colspan="2">
<font face="Tahoma">This is my <input tabindex="25" type="radio" checked value="H" name="AddType"> home <input tabindex="26" type="radio" value="B" name="AddType"> business address.</font>
            </td>
</tr>
<tr>
<td width="591" height="12" valign="middle" bgcolor="#e4f0f0" colspan="5">
<font face="Tahoma">
<strong>Payment Information</strong></font>
            </td>
</tr>
<tr>
<td width="111" height="13" valign="middle">
<font face="Tahoma">Total Amount to be Charged<font color="#ff0000">*</font>
              </font>
            </td>
<td width="163" valign="middle">
<font face="Tahoma">$ <input tabindex="29" required="true" type="text" size="10" style="width: 78px; height: 22px;" name="x_amount"></font>
            </td>
<td width="42" valign="middle"> </td>
<td width="91" valign="middle"> </td>
<td width="184" height="13" valign="middle"> </td>
</tr>
<tr>
<td width="111" height="13" valign="middle">
<font face="Tahoma">Card Type<font color="#ff0000">*</font>
              </font>
            </td>
<td width="163" valign="middle">
<select tabindex="30" class="light" name="x_card_type">
<option selected value="Please Select">Please Select</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>
</select></td>
<td width="42" valign="middle"> </td>
<td width="91" valign="middle">
<font face="Tahoma">Expiration Date<font color="#ff0000">*</font>
              </font>
            </td>
<td width="184" height="13" valign="middle">
<select tabindex="32" class="light" name="x_exp_month">
<option selected value="Month">Month</option>
<option value="01">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>
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<option value="2028">2028</option>
<option value="2029">2029</option>
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