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	Old Saybrook Menorah Lighting - Chabad-Lubavitch of the Shoreline
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</label></div><div id="cid_7" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_7" name="q7_number" 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_10"><div class="form-label-left" id="label_10"><label for="input_10"> Number of children </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_10" name="q10_number10" 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_6"><div class="form-label-left form-label-hidden" id="label_6"></div><div id="cid_6" 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_6" /><label 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class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_13_2" name="q13_input13" value="540" /><label for="input_13_2"><span>$540</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_13_3" name="q13_input13" value="1000" /><label for="input_13_3"><span>$1000</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_13_4" name="q13_input13" value="1800" /><label for="input_13_4"><span>$1800</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio" name="q13_input13" id="other_13" value="" /><span><input type="number" min="1" class="form-radio-other-input form-textbox" onkeypress="validateNumber(event)" name="q13_input13[other]" data-otherhint="Other" size="15" id="input_13" disabled="disabled" 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form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q12_payment[cc_number]" id="input_12_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_12_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td></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="q12_payment[cc_nameOnCard]" id="input_12_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_12_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="q12_payment[cc_exp_month]" id="input_12_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_12_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="q12_payment[cc_exp_year]" id="input_12_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 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