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	Passover Partner - Chabad of Chula Vista
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<form class="userform-form" action="" method="post" name="form_5065272" id="5065272" accept-charset="utf-8"><input type="hidden" name="formID" value="5065272" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_11"><div id="cid_11" class="form-input-wide"> <img alt="" class="form-image" border="0" src="https://w2.chabad.org/media/images/80588.jpg" height="367" width="438" /> </div></li><li class="form-line" id="id_1"><div id="cid_1" class="form-input-wide"> <div id="text_1" class="form-html"><p>Chabad of Chula Vista will be gifting Shmurah Matzah packages, hosting a Community Seder, and helping families in need with all their Passover neccesities. </p>

<p>The expenses of all these are large.</p>

<p><strong>Please consider becoming a Passover sponsor helping hundreds enjoy the beautiful holiday celebrations! </strong></p>
</div> </div></li><li class="form-line" id="id_2"><div class="form-label-top" id="label_2"><label for="input_2"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_2"> </label></div><div id="cid_2" class="form-input-wide"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q2_fullName[first]" id="first_2" autocomplete="given-name" />  <label class="form-sub-label" for="first_2" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q2_fullName[last]" id="last_2" autocomplete="family-name" />  <label class="form-sub-label" for="last_2" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_3"><div class="form-label-top" id="label_3"><label for="input_3"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_3"> </label></div><div id="cid_3" class="form-input-wide"> <input type="email" class=" form-textbox validate[required, Email]" id="input_3" name="q3_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_8"><div class="form-label-top" id="label_8"><label for="input_8"> Phone Number </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" class="form-input-wide"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q8_phoneNumber[area]" id="input_8_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_8_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q8_phoneNumber[phone]" id="input_8_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_8_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_5"><div class="form-label-top" id="label_5"><label for="input_5"> Sponsorship Opportunities  </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input-wide"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_5_0" name="q5_input5[]" value="Passover Sponsor - $3600" /><label id="label_input_5_0" for="input_5_0"><span>Passover Sponsor - $3600</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_5_1" name="q5_input5[]" value="Matzah Sponsor - $1800" /><label id="label_input_5_1" for="input_5_1"><span>Matzah Sponsor - $1800</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_5_2" name="q5_input5[]" value="Seder Sponsor - $1000" /><label id="label_input_5_2" for="input_5_2"><span>Seder Sponsor - $1000</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_5_3" name="q5_input5[]" value="Wine Sponsor - $500" /><label id="label_input_5_3" for="input_5_3"><span>Wine Sponsor - $500</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_5_4" name="q5_input5[]" value="Freedom Sponsor - $360" /><label id="label_input_5_4" for="input_5_4"><span>Freedom Sponsor - $360</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_5_5" name="q5_input5[]" value="Exodus Sponsor - $180" /><label id="label_input_5_5" for="input_5_5"><span>Exodus Sponsor - $180</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_5_6" name="q5_input5[]" value="Other amounts" /><label id="label_input_5_6" for="input_5_6"><span>Other amounts</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_10"><div class="form-label-top" id="label_10"><label for="input_10"> Amount: </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input-wide"> <div class="form-single-column"><span class="form-radio-item simple-mode"><label id="label_input_10" for="input_10"><span>$</span></label><input type="number" class="form-textbox" id="input_10" name="q10_input10" value="" onkeypress="validateNumber(event)" /></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_4"><div class="form-label-top" id="label_4"><label for="input_4"> Total </label></div><div id="cid_4" class="form-input-wide"> <div id="total_amount">$0.00 </div> </div></li><li class="form-line" id="id_7"><div class="form-label-top" id="label_7"><label for="input_7"> Payment </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input-wide"> <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_7_creditCard" name="q7_payment[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_7_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_7_other" name="q7_payment[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_7_other">Check/Cash</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="q7_payment[cc_type]" id="input_7_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="q7_payment[cc_number]" id="input_7_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_7_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="q7_payment[cc_ccv]" id="input_7_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_7_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="q7_payment[cc_nameOnCard]" id="input_7_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_7_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="q7_payment[cc_exp_month]" id="input_7_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_7_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="q7_payment[cc_exp_year]" id="input_7_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_7_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">Please mail check to:<br />Chabad of Chula Vista<br />2086 Otay Lakes Rd #101<br />Chula Vista, CA 91913</td></tr><tr class="billing_address hide"><th colspan="2">Billing Address</th></tr><tr class="billing_address hide"><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q7_payment[addr_line1]" id="input_7_addr_line1" autocomplete="billing address-line1" />  <label class="form-sub-label" for="input_7_addr_line1" id="sublabel_7_addr_line1">Street Address</label></span></td></tr><tr class="billing_address hide"><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" name="q7_payment[city]" id="input_7_city" autocomplete="billing address-level2" />  <label class="form-sub-label" for="input_7_city" id="sublabel_7_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q7_payment[state]" id="input_7_state" autocomplete="billing address-level1" />  <label class="form-sub-label" for="input_7_state" id="sublabel_7_state">State / Province</label></span></td></tr><tr class="billing_address hide"><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-postal" type="text" name="q7_payment[postal]" id="input_7_postal" size="10" autocomplete="billing postal-code" />  <label class="form-sub-label" for="input_7_postal" id="sublabel_7_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q7_payment[country]" id="input_7_country" autocomplete="billing country-name"><option value="" selected="selected">Please Select</option><option value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option 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