<!DOCTYPE HTML PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">

<html xmlns="http://www.w3.org/1999/xhtml" >
<head id="Head1">
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta http-equiv="Content-Language" content="en" />

<meta name="keywords" content="Purim,Form" />
<meta name="title" content="Purim Form - Chabad of Plantation" />
<meta property="og:type" content="website" />
<meta name="scope-aids" content="256768-256776-714511-4297262-4646918-4648787" />
<meta name="article-keywords" content="23083-2185-16403-20429-8495-2170-2898-20962" />
<meta name="scope-aid" content="256768" />
<meta name="scope-aid" content="256776" />
<meta name="scope-aid" content="714511" />
<meta name="scope-aid" content="4297262" />
<meta name="scope-aid" content="4646918" />
<meta name="scope-aid" content="4648787" />
<meta name="article-keyword" content="23083" />
<meta name="article-keyword" content="2185" />
<meta name="article-keyword" content="16403" />
<meta name="article-keyword" content="20429" />
<meta name="article-keyword" content="8495" />
<meta name="article-keyword" content="2170" />
<meta name="article-keyword" content="2898" />
<meta name="article-keyword" content="20962" />
<meta property="og:url" content="https://www.chabadplantation.com/templates/articlecco_cdo/aid/4648787/jewish/Megillah-Readings-Sponsor.htm" />
<meta property="twitter:card" content="summary_large_image" />
<meta property="twitter:site" content="@chabad" />
<meta property="og:title" content="Purim Form" /><link rel="canonical" href="https://www.chabadplantation.com/templates/articlecco_cdo/aid/4648787/jewish/Megillah-Readings-Sponsor.htm" />
<link rel="Stylesheet" href="/css/fonts/font-awesome/font-awesome-5.css?v=98662BF4" id="kfont-awesome" type="text/css"/>
<link rel="Stylesheet" href="/css/DefaultGrid.css?v=44B79007" id="kgrid" type="text/css"/>
<link rel="Stylesheet" href="/css/Elements.css?v=E669C926" id="k6" type="text/css"/>
<link rel="Stylesheet" href="/css/vendor/ds/tokens/sites.css?v=A6ADC6CE" id="ksites-ds-css" type="text/css"/>
<link rel="Stylesheet" href="/css/new/main.css?v=2B7F734E" id="k7" type="text/css"/>
<link rel="Stylesheet" href="https://w2.chabad.org/css/cco/minisites/global.css" id="k20962" type="text/css"/>
<link rel="Stylesheet" href="/css/old/global.css?v=F7C22456" id="k2898" type="text/css"/>
<link rel="Stylesheet" href="https://w2.chabad.org/images/Shluchim/minisites/themes/purim/purim-minisite.css?v=1" id="k23083" type="text/css"/>
<link rel="Stylesheet" href="/css/cco/templates/forms/formCss2.css?v=9F45CAAB" id="kFormCss" type="text/css"/>
<link rel="Stylesheet" href="/css/cco/templates/forms/themes/nova.css?v=25554DFF" id="kNova" type="text/css"/>
<link rel="Stylesheet" href="/css/bootstrap/grid.css?v=B92FCAD8" id="kbootstrap4-grid" type="text/css"/>
<link rel="Stylesheet" href="/css/Library/reader-comments.css?v=5F31D0D8" id="kCommentsStylesheet" type="text/css"/>
<link rel="Stylesheet" href="/css/inline/BookInfo.css?v=14B88022" id="kBookInfoCss" type="text/css"/>

<script>$q=[];$j=function(f){$q.push(f);}</script>
	
 
	
	<style type="text/css">
		body{margin:0;}
	</style>
	
	



<script>
	window.dataLayer = window.dataLayer || [];
	dataLayer.push({"event":"datalayer-initialized","page":{"numberOfComments":0,"publicationDate":"2020-02-14","primaryArticleId":4648787,"title":"Purim Form","author":"","authorId":0,"contentLevel1":"My Site","contentLevel2":"Holidays","contentLevel3":"Purim","contentLevel4":"Megillah Readings","contentLevel5":"Megillah Readings Sponsor","siteName":"Chabad of Plantation"},"time":{"upcomingHoliday":"Shavuot","daysToUpcomingHoliday":14,"hebrewDate":"5786-02-21"}});
		dataLayer.push({ 'articleHierarchy': '-256768-256776-714511-4297262-4646918-4648787-', 'keywords': '-k20962-k2898-k2170-k8495-k20429-k16403-k2185-k23083-', 'k': '-256768-256776-714511-4297262-4646918-4648787--k20962-k2898-k2170-k8495-k20429-k16403-k2185-k23083-' });
	
</script>
<script>

(function(c,h,a,b,a,d){c[a]=c[a]||[];c[a].push({'gtm.start':
new Date().getTime(),event:'gtm.js'});var f=h.getElementsByTagName(b)[0],
j=h.createElement(b);j.async=true;
j.src='https://w6.chabad.org/mitzvah-tank.js';f.parentNode.insertBefore(j,f);
})(window,document,0,'script','dataLayer');</script>

	<!-- Start of StatCounter Code -->
	<script type="text/javascript">
	var sc_project = 3943423;var sc_partition = 47;var sc_invisible = 1;var sc_remove_link=1;var sc_security = "2b25c8e1";var sc_https = 1;
	</script>
	<script type="text/javascript" src="https://secure.statcounter.com/counter/counter_xhtml.js" defer async></script>
	<noscript><img src="//c48.statcounter.com/counter.php?sc_project=3943423&amp;java=0&amp;security=2b25c8e1&amp;invisible=1" border="0" /> </noscript>
	<!-- End of StatCounter Code -->

<title>
	Purim Form - Chabad of Plantation
</title></head>
<body class="lang_en dir_ltr cco_body form secure cco_templateless_page section_branch">
	
	
		<div width="100%" class="cco_templateless_template" style="z-index:100 !important;display:block !important;left:0px !important;top:0px !important;height:30px!important;width:100% !important;line-height:30px !important; position:relative !important; margin-bottom:0 !important; padding:0;text-indent: 25px;" align="Left"><a href="//www.ChabadPlantation.com" style="display:block!important;font-size:14px !important;">&laquo; Back to&nbsp;Chabad of Plantation</a></div>
	
	<div class="cco_templatelates_content">
		
	<div class="co_content_container clearfix local_content" id="co_content_container">
		<div class="clearfix">
			<!-- BEGIN HEADER -->
<div id="chabad_body_page">
<div id="chabad_main_content">
<div id="chabad_head">


<div class="chabad_header">
<div class="headerTitle">
<a href="/4297262" style="text-decoration: none;">
 
PURIM</a>
</div>
<div class="centerName">
 
At Chabad of Plantation
</div>

</div>

<div class="holidayDates">



<div class="widget-1 holiday_date custom v260 feed">
<div class="wrapper">

<div class="widget_header">
<h5>Holiday Date</h5>    
</div>
<div class="widget_content">
February 20 - 21, 2027</div></div>
</div>


</div>

<div id="navigation" class="chabad_navigator_bar">
<div class="chabad_menu_content">
<ul id="menu" class="navi">
<li class="item parent">
<a href="/article.asp?aid=4297262" class="parent">Home</a>
|
</li>
<li class="item parent">
<a href="/article.asp?aid=5416153" class="parent">Mystery Purim - Grand Purim Party</a>
|
</li>
<li class="item parent arrow selected">
<a href="/article.asp?aid=4646918" class="parent arrow selected">Megillah Readings</a>
<div class="sub_menu">
<ul>
<li class="item first last selected">
<a href="/article.asp?aid=4648787">Megillah Readings Sponsor</a>
</li>
</ul>
</div>
|
</li>
<li class="item parent">
<a href="/article.asp?aid=4327453" class="parent">Matanot L'Evyonim - Charity For The Poor</a>
|
</li>
<li class="item parent">
<a href="/article.asp?aid=3943021" class="parent">Shalach Manot</a>
|
</li>
<li class="item parent">
<a href="/article.asp?aid=5053493" class="parent">Shalach Manot Pick Up</a>
</li>

</ul>
</div>
</div>



</div>
<div id="chabad_body_content">
<div class="chabad_left_column">
<div detached="true" type="static" id="ContentArea" name="content_area" actions="edit,delete" class="chabad_left_column"><div id="content_page" class="content_page"><!-- END HEADER -->
			
			
			<div class="clearfix bh mobile-only align_right">ב"ה</div>
			
				<div class="master-content-wrapper " >
					

<header class="article-header cf ">
	
	
			<h1 class="article-header__title js-article-title js-page-title">Megillah Readings Sponsor</h1>
		
			<div>
				
			</div>
		
</header>
				</div>
			
			<div class="body_wrapper clearfix co_body">
				<div class="" id="co_body_container">
					
					<div id="ContentBody">
						
						
							<div class="content-area-parent no_margin">
								
	<div id="cco_body">
		<div class="content  no_margin no_overflow" id="co_content_container">
			
			
	

	<article class="content js-content" >
	

<div id="formContainer"><script type="text/javascript">var defaultCurrency = { value: 'USD', symbol: '$'};
$j(function(){
window.multiplier = 0;
window.formJson = Object.extend([{"form_height":457,"18_text":"Image","18_message":"","18_src":"https://w2.chabad.org/media/images/941/ZcUJ9415779.jpg","18_link":"","18_target":"_blank","18_height":250,"18_width":765,"18_align":"Left","18_description":"","18_name":"image","18_qid":18,"18_type":"control_image","18_order":1,"9_text":"Full Name","9_message":"","9_labelAlign":"Left","9_required":"Yes","9_prefix":"No","9_suffix":"No","9_middle":"No","9_description":"","9_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"9_readonly":"No","9_name":"fullName9","9_qid":9,"9_type":"control_fullname","9_order":2,"10_receivesReceipts":"Yes","10_text":"E-mail","10_message":"","10_labelAlign":"Auto","10_required":"Yes","10_size":30,"10_validation":"Email","10_maxsize":"","10_defaultValue":"","10_subLabel":"","10_hint":"ex: myname@example.com","10_description":"","10_confirmation":"No","10_confirmationHint":"Confirm Email","10_readonly":"No","10_name":"email10","10_qid":10,"10_type":"control_email","10_order":3,"10_shrink":"No","12_text":"Phone Number","12_message":"","12_labelAlign":"Auto","12_required":"Yes","12_validation":"Numeric","12_countryCode":"No","12_inputMask":"disable","12_inputMaskValue":"(###) ###-####","12_description":"","12_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"12_readonly":"No","12_name":"phoneNumber12","12_qid":12,"12_type":"control_phone","12_order":4,"12_shrink":"No","14_text":"Adults","14_message":"","14_labelAlign":"Left","14_required":"No","14_size":"5","14_maxsize":"","14_minValue":"","14_maxValue":"","14_defaultValue":"","14_subLabel":"","14_hint":"ex: 2","14_description":"","14_readonly":"No","14_pricePerItem":"15","14_name":"adults","14_qid":14,"14_type":"control_number","14_order":5,"14_shrink":"Yes","15_text":"Children","15_message":"","15_labelAlign":"Left","15_required":"No","15_size":5,"15_maxsize":"","15_minValue":"","15_maxValue":"","15_defaultValue":"","15_subLabel":"","15_hint":"ex: 2","15_description":"","15_readonly":"No","15_pricePerItem":"10","15_name":"children","15_qid":15,"15_type":"control_number","15_order":6,"15_shrink":"Yes","25_text":"I want to sponsor","25_message":"","25_labelAlign":"Left","25_required":"No","25_options":"360.00|500.00|770.00|1000","25_special":"None","25_allowOther":"Yes","25_otherText":"Other","25_selected":"","25_spreadCols":"3","25_description":"","25_mode":"radio_buttons","25_name":"iWant","25_qid":25,"25_type":"control_amount","25_order":7,"5_labelAlign":"Auto","5_text":"Total Charge","5_partialPayEnabled":"No","5_partialPayType":"dollar","5_partialPayMinimum":0,"5_required":"No","5_offsetGiftEnabled":"No","5_offsetGift":3,"5_name":"totalCharge","5_qid":5,"5_type":"control_totalamount","5_order":8,"5_shrink":"No","5_newLine":"No","1_text":"Payment Method","1_message":"","1_labelAlign":"Top","1_required":"No","1_duplicatable":false,"1_selectedCountry":"","1_description":"","1_sublabels":{"cc_firstName":"First Name","cc_lastName":"Last Name","cc_type":"Credit Card Type","cc_number":"Credit Card Number","cc_ccv":"Security Code","cc_nameOnCard":"Name on Card","cc_IdNumber":"Israel Identity Number","cc_exp_month":"Expiration Month","cc_exp_year":"Expiration Year","eCheck_bankName":"Bank Name","eCheck_routingNumber":"Routing Number","eCheck_accountNumber":"Account Number","eCheck_accountType":"Account Type","addr_line1":"Street Address","addr_line2":"Street Address Line 2","city":"City","state":"State / Province","postal":"Postal / Zip Code","country":"Country"},"1_name":"paymentMethod","1_qid":1,"1_type":"control_payform","1_order":9,"1_options":{"currency":"4494|$|USD","creditCard":{"value":"Credit Card","enabled":true,"fields":[{"name":"ccv","value":"CCV","enabled":true},{"name":"nameOnCard","value":"Name on Card","enabled":true},{"name":"billingAddress","value":"Billing Address","enabled":false}],"processorIndex":3,"type":[{"name":"Visa","value":"Visa","enabled":true},{"name":"Mastercard","value":"MasterCard","enabled":true},{"name":"Amex","value":"American Express","enabled":true},{"name":"Discover","value":"Discover","enabled":true}],"payMe":false},"paypal":{"value":"Paypal","enabled":false,"processorIndex":null},"eCheck":{"value":"eCheck","enabled":false},"other":{"value":"Other","enabled":true,"message":""}},"1_shrink":"Yes","17_text":"Comments? Questions?","17_message":"","17_labelAlign":"Top","17_required":"No","17_cols":40,"17_rows":"1","17_validation":"None","17_entryLimit":"None-0","17_maxsize":"","17_defaultValue":"","17_subLabel":"","17_hint":"","17_description":"","17_readonly":"No","17_wysiwyg":"Disable","17_name":"commentsQuestions17","17_qid":17,"17_type":"control_textarea","17_order":10,"17_shrink":"Yes","19_text":"Optin","19_labelAlign":"Top","19_description":"","19_required":"No","19_list":"-1","19_duplicatable":false,"19_message":"","19_name":"optin","19_qid":19,"19_type":"control_optin","19_order":11,"19_shrink":"Yes","19_newLine":"Yes","2_text":"Submit","2_buttonAlign":"Auto","2_clear":"No","2_print":"No","2_name":"submit","2_qid":2,"2_type":"control_button","2_order":12,"form_title":"Kosher Meal","form_pagetitle":"Form","form_styles":"nova","form_font":"","form_fontsize":"14","form_fontcolor":"","form_optioncolor":"","form_lineSpacing":"12","form_background":"","form_formWidth":"685","form_labelWidth":"150","form_alignment":"Left","form_thankurl":"","form_thanktext":"","form_highlightLine":"Enabled","form_activeRedirect":"default","form_sendpostdata":"No","form_unique":"None","form_uniqueField":"\u003cField Id\u003e","form_status":"Enabled","form_injectCSS":"","form_hideMailEmptyFields":"disable","form_showProgressBar":"disable","form_formStrings":[{"alphabetic":"This field can only contain letters","alphanumeric":"This field can only contain letters and numbers.","confirmClearForm":"Are you sure you want to clear the form?","confirmEmail":"E-mail does not match","email":"Enter a valid e-mail address","generalError":"There are errors on the form. Please fix them before continuing.","generalPageError":"There are errors on this page. Please fix them before continuing.","gradingScoreError":"Score total should only be less than or equal to","incompleteFields":"There are incomplete required fields. Please complete them.","inputCarretErrorA":"Input should not be less than the minimum value:","inputCarretErrorB":"Input should not be greater than the maximum value:","lessThan":"Your score should be less than or equal to","maxDigitsError":"The maximum digits allowed is","maxSelectionsError":"The maximum number of selections allowed is","minSelectionsError":"The minimum required number of selections is","multipleFileUploads_emptyError":"{file} is empty, please select files again without it.","multipleFileUploads_minSizeError":"{file} is too small, minimum file size is {minSizeLimit}.","multipleFileUploads_onLeave":"The files are being uploaded, if you leave now the upload will be cancelled.","multipleFileUploads_sizeError":"{file} is too large, maximum file size is {sizeLimit}.","multipleFileUploads_typeError":"{file} has invalid extension. Only {extensions} are allowed.","numeric":"This field can only contain numeric values","pastDatesDisallowed":"Date must not be in the past.","pleaseWait":"Please wait...","required":"This field is required.","requireEveryRow":"Every row is required.","requireOne":"At least one field required.","submissionLimit":"Sorry! Only one entry is allowed.  Multiple submissions are disabled for this form.","uploadExtensions":"You can only upload following files:","uploadFilesize":"File size cannot be bigger than:"}],"form_limitSubmission":"No Limit","form_expireDate":"No Limit","form_messageOfLimitedForm":"This form is currently unavailable!","form_emails":[],"form_language":"","form_sendEmail":"Yes","form_style":"Default","form_theme":"nova","form_id":4648787,"form_formStringsChanged":"yes","form_slug":4648787,"form_stopHighlight":"Yes"}][0] || {}, window.formJson || {});
window.isSecureForm = true
});

			if (typeof(Userform) ==='undefined')
			{
				Userform={init:function(args){
					$j(function(){
						Userform.init.apply(Userform, [args]);
					})
				},
				setConditions:function(args){
					$j(function(){
						Userform.setConditions.apply(Userform, [args]);
					})
				}};
			}
</script><script type="text/javascript">
   Userform.init(function(){
      $('input_10').hint('ex: myname@example.com');
      $('input_14').hint('ex: 2');
      $('input_15').hint('ex: 2');
      Userform.alterTexts({"alphabetic":"This field can only contain letters","alphanumeric":"This field can only contain letters and numbers.","confirmClearForm":"Are you sure you want to clear the form?","confirmEmail":"E-mail does not match","email":"Enter a valid e-mail address","generalError":"There are errors on the form. Please fix them before continuing.","generalPageError":"There are errors on this page. Please fix them before continuing.","gradingScoreError":"Score total should only be less than or equal to","incompleteFields":"There are incomplete required fields. Please complete them.","inputCarretErrorA":"Input should not be less than the minimum value:","inputCarretErrorB":"Input should not be greater than the maximum value:","lessThan":"Your score should be less than or equal to","maxDigitsError":"The maximum digits allowed is","maxSelectionsError":"The maximum number of selections allowed is","minSelectionsError":"The minimum required number of selections is","multipleFileUploads_emptyError":"{file} is empty, please select files again without it.","multipleFileUploads_minSizeError":"{file} is too small, minimum file size is {minSizeLimit}.","multipleFileUploads_onLeave":"The files are being uploaded, if you leave now the upload will be cancelled.","multipleFileUploads_sizeError":"{file} is too large, maximum file size is {sizeLimit}.","multipleFileUploads_typeError":"{file} has invalid extension. Only {extensions} are allowed.","numeric":"This field can only contain numeric values","pastDatesDisallowed":"Date must not be in the past.","pleaseWait":"Please wait...","required":"This field is required.","requireEveryRow":"Every row is required.","requireOne":"At least one field required.","submissionLimit":"Sorry! Only one entry is allowed.  Multiple submissions are disabled for this form.","uploadExtensions":"You can only upload following files:","uploadFilesize":"File size cannot be bigger than:"});
   });
</script>
<style type="text/css" id="GenFormStyles">
    .form-label{
        width:150px !important;
    }
    .form-label-left{
        width:150px !important;
    }
    .form-line{
        padding-top:12px;
        padding-bottom:12px;
    }
    .form-label-right{
        width:150px !important;
    }
    .form-all {
        font-size:14px;
    }
.co_body .content .form-all p {
 font-size:14px;

}
@media screen and (max-width: 600px) {.form-label-left{	float:none;	display:block;}.form-buttons-wrapper.button-align-auto{text-indent: 0!important;}}</style>

<form class="userform-form" action="" method="post" name="form_4648787" id="4648787" accept-charset="utf-8"><input type="hidden" name="formID" value="4648787" /><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/941/ZcUJ9415779.jpg" height="250" width="765" /> </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 class="form-line" id="id_14"><div class="form-label-left" id="label_14"><label for="input_14"> Adults </label><label class="label-message" for="input_14"> </label></div><div id="cid_14" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_14" name="q14_adults" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> Children </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_15" name="q15_children" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_25"><div class="form-label-left" id="label_25"><label for="input_25"> I want to sponsor </label><label class="label-message" for="input_25"> </label></div><div id="cid_25" class="form-input"> <div class="form-multiple-column" data-columns="3"><span class="form-radio-item"><input type="radio" class="form-radio" id="input_25_0" name="q25_iWant" value="360.00" /><label for="input_25_0"><span>$360.00 USD</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_25_1" name="q25_iWant" value="500.00" /><label for="input_25_1"><span>$500.00 USD</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_25_2" name="q25_iWant" value="770.00" /><label for="input_25_2"><span>$770.00 USD</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_25_3" name="q25_iWant" value="1000" /><label for="input_25_3"><span>$1000 USD</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio" name="q25_iWant" id="other_25" value="" /><span><input type="number" min="1" class="form-radio-other-input form-textbox" onkeypress="validateNumber(event)" name="q25_iWant[other]" data-otherhint="Other" size="15" id="input_25" disabled="disabled" /></span><br /></span></div> </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">Other</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"></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? Questions? </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input"> <textarea id="input_17" class="form-textarea" name="q17_commentsQuestions17" cols="40" rows="1"></textarea> </div></li><li class="form-line" id="id_19"><div class="form-label-left form-label-hidden" id="label_19"></div><div id="cid_19" class="form-input"> <div class="form-single-column form-checkbox-item"><input name="optin" value="true" type="checkbox" checked="checked" class="form-checkbox" id="input_19" /><label id="label_input_19" for="input_19">I would like to receive news and updates by email</label></div> </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" name="simple_spc" value="4648787" /><script type="text/javascript">document.getElementById("si"+"mple"+"_spc").value = "4648787-4648787";</script><div>


<script>
	var recaptchaIsEnterprise = false;
		 var recaptchaV2Key = "6LcG_TcUAAAAAKAVgwgW39ujc9OCjXSoQYFIA-Su";

</script>

	<input type="hidden" class="js-recaptcha-input" name="cdo-captcha-response" value="" data-div-id="23977025-37b7-4b14-a3c7-25174f9a4920" data-processed="false" />
	<div class="js-recaptcha-wrapper" id="23977025-37b7-4b14-a3c7-25174f9a4920"></div>	
</div></form></div>
<div class="center small">
	<img valign="absbottom" src="https://w2.chabad.org/images/global/icons/lock.gif" width="16" height="16" alt="Secure"> This page uses TLS encryption to keep your data secure.
</div>
	<div class="break_floats"></div>
	

<div class="content-footer">
	<!-- END CACHE -->
	
	
	
	
	
</div>
	</article>

		</div>
	</div>
</div>
						
						<div class="break_floats"></div>
						
					</div>
				</div>
				
				
				
			</div>
			
			<!-- BEGIN FOOTER -->

</div>
<div id="border_bottom">
</div>
</div>
</div>
</div>
<!-- END FOOTER -->
		</div>
		
		<aside class="page-tools-sidebar js-page-tools-sidebar hide_for_print">
<div class="page-tools js-page-tools-menu">
<div class="page-tools__section page-tools__section--share">
<a class="page-tools__tool js-share-popup page-tools__tool--facebook" data-share-url="https://www.facebook.com/dialog/share?app_id=188669250943&amp;display=popup&amp;href=https%3a%2f%2fwww.chabadplantation.com%2ftemplates%2farticlecco_cdo%2faid%2f4648787%2fjewish%2fMegillah-Readings-Sponsor.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dFB">
				<i class="fa fa-facebook"></i>
			</a>
<a class="page-tools__tool js-share-popup page-tools__tool--twitter" data-share-url="https://twitter.com/intent/tweet?text=Purim+Form+-+Chabad+of+Plantation&amp;url=https%3a%2f%2fwww.chabadplantation.com%2ftemplates%2farticlecco_cdo%2faid%2f4648787%2fjewish%2fMegillah-Readings-Sponsor.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dtwitter&amp;via=Chabad">
				<i class="fa fa-twitter"></i>
			</a>
<a class="page-tools__tool js-share-popup page-tools__tool--whatsapp d-lg-none js-share-whatsapp" data-share-url="whatsapp://send?text=Purim+Form+-+Chabad+of+Plantation https%3a%2f%2fwww.chabadplantation.com%2ftemplates%2farticlecco_cdo%2faid%2f4648787%2fjewish%2fMegillah-Readings-Sponsor.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dwhatsapp">
				<i class="fa fa-whatsapp">
					<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 50 50" fill="#128c7e" width="1em" height="1em"><path d="M25 2C12.318 2 2 12.318 2 25c0 3.96 1.023 7.854 2.963 11.29L2.037 46.73c-.096.343-.003.711.245.966.191.197.451.304.718.304.08 0 .161-.01.24-.029l10.896-2.699C17.463 47.058 21.21 48 25 48c12.682 0 23-10.318 23-23S37.682 2 25 2zm11.57 31.116c-.492 1.362-2.852 2.605-3.986 2.772-1.018.149-2.306.213-3.72-.231-.857-.27-1.957-.628-3.366-1.229-5.923-2.526-9.791-8.415-10.087-8.804-.295-.389-2.411-3.161-2.411-6.03s1.525-4.28 2.067-4.864c.542-.584 1.181-.73 1.575-.73s.787.005 1.132.021c.363.018.85-.137 1.329 1.001.492 1.168 1.673 4.037 1.819 4.33.148.292.246.633.05 1.022s-.294.632-.59.973-.62.76-.886 1.022c-.296.291-.603.606-.259 1.19s1.529 2.493 3.285 4.039c2.255 1.986 4.158 2.602 4.748 2.894.59.292.935.243 1.279-.146.344-.39 1.476-1.703 1.869-2.286s.787-.487 1.329-.292c.542.194 3.445 1.604 4.035 1.896.59.292.984.438 1.132.681.148.242.148 1.41-.344 2.771z"/></svg>
				</i>
			</a>
<a class="page-tools__tool js-share-popup page-tools__tool--pinterest d-none d-lg-block" data-share-url="http://pinterest.com/pin/create/button/?url=https%3a%2f%2fwww.chabadplantation.com%2ftemplates%2farticlecco_cdo%2faid%2f4648787%2fjewish%2fMegillah-Readings-Sponsor.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dpinterest&amp;description=Purim+Form+-+Chabad+of+Plantation">
				<i class="fa fa-pinterest"></i>
			</a>
<a class="page-tools__tool" onclick="showEmailLayer(this);">
<i class="fa fa-envelope"></i>
</a>
</div>
<div class="page-tools__section page-tools__section--other js-page-tool-other">
<div class="page-tools__tool popover-parent d-lg-block">
<div class="popover popover--right align_left nowrap">
<div class="popover__content">
<label class="bold bottom_margin block">
Print Options:
</label>
<form class="vcenter" name="print-form" onsubmit="coPrint(event, 4646918);return false;">
<div>
<label><input type="checkbox" name="print-green"><span title="Save paper and ink">Print without images <i class="fa fa-leaf text-green"></i></span></label>
</div>
<br/>
<div class="center">
<button class="co-button page-tools__print-button">Print</button>
</div>
</form>
</div>
</div>
<i class="fa fa-print"></i>
</div>
</div>
</div>
<div class="js-fab-wrapper fab-wrapper">
<div class="fab">
<i class="fab-icon"></i>
</div>
</div>
</aside>
<!-- END CACHE -->
	</div>

	</div>

	<div id="BodyContainer">
		<div class="g960 footer">
			<div class="poweredby large_bottom_margin">
				



	<div class="footer3">
		<span class="footer-title" >Chabad of Plantation</span>
		<div class="footer-address">
			<span class="footer-street">10165 Cleary Boulevard </span>
			<span class="footer-city-state">Plantation, FL 33324-1068</span>
		</div>
			<span>954-370-2289</span>
	</div>
	<img src="https://w2.chabad.org/images/global/spacer.gif" width="1" height="6" border="0" /><br />



Powered by <a href="https://www.chabad.org/" target="_new" class="">Chabad.org</a> &copy; 1993-2026 <a href="/4026210" target="_blank" class="privacy-link">Privacy Policy</a>




			</div>
		</div>
	</div>
	
	

	
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/os/jquery-latest.min.js?v=0293E3EC"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/os/jquery/jquery.inputmask.min.js?v=BF33D3B4"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/co/dist/CoLib.js?v=87098EA1"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/WebComponents/bundles/magen-cdo-global.js?v=F6438A68"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/multimedia/infolayer.js?v=ED1B8531"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/templates/forms/userform.js?v=7F5B58AF"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/commentsloader.js?v=AD6AAB79"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/minisites.js?v=F38E4DA5"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/subscribeprompt.js?v=86D84DC2"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/templates/FormDecoder.js?v=83AF6F1A"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/modules/pagetools.js?v=930B07AB"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/deprecated.js?v=D506A83E"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/OverrideJSDocumentWrite.js?v=9A0227AA"></script><script>$j = $j.fn ? $j : jQuery;$j(()=>{$q.forEach(f=>{try{f.call(window);}catch(ex){console.error(ex);}});})</script>
	

<script  language="javascript" type="text/javascript"> Co.Settings      = {CacheClassName:'js-cache-default',MosadName:'Chabad of Plantation'}; Co.ArticleId     = '4648787';Co.SectionId     = 714511;Co.PartnerSiteId = 0;Co.SiteId        = 3;Co.IsMobilePage  = false;Co.IsResponsive  = false;Co.DbDomain      = 'ChabadPlantation.com';Co.LanguageCode  = '';Co.LoginStatus   = 'None';</script>
	
	
</body>
</html>