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	Reservations & Greetings - Lubavitch Chabad of Skokie
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	.sPromo-wrap a {
		position: absolute;
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		height: 100%;
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		object-fit: cover;
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		display: block;
		width: 100%;
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		font-family: Oswald, Arimo, sans-serif;
		position: absolute;
		width: 100%;
		bottom: 0;
		height: 38px;
		line-height: 36px;
		font-weight: 400;
		font-size: 15pt;
		overflow: hidden;
		text-overflow: ellipsis;
		white-space: nowrap;
		background: rgba(255, 255, 255, 0.75);
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	.sPromo-wrap:hover img {
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	.sPromo-flex {
		max-height: 250px;
		flex: 1 1 250px;
		min-width: 200px;
		max-width: 500px;
		text-align: center;
		display: inline-block;
		position: relative;
		border: 1px solid #c3c1b8;
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	.sPromo-flex a {
		position: absolute;
		width: 100%;
		height: 100%;
		left: 0;
		right: 0;
		z-index: 1;
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	.sPromo-flex img {
		height: 100%;
		object-fit: cover;
		opacity: 1;
		display: block;
		width: 100%;
		transition: 0.5s ease;
		backface-visibility: hidden;
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	div#chabad_main_content {
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	.article-header__title {
		font-size: 30px;
		color: #66635b;
		font-family: Montserrat, sans-serif;
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	.wrap-image .bannerContainer img {
		opacity: 1;
		display: block;
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	.wrap-image:hover .bannerContainer img {
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	.wrap-image:hover .wrap-image2 {
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	.wrap-image2 {
		transition: 0.5s ease;
		opacity: 0;
		position: absolute;
		top: 50%;
		left: 50%;
		-ms-transform: translate(-50%, -50%);
		-webkit-transform: translate(-50%, -50%);
		transform: translate(-50%, -50%);
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	.custom_message {
		margin-bottom: 50px;
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	.custom_message .message {
		font-family: Montserrat, sans-serif;
		font-size: 16pt;
		margin: 0 auto;
		text-align: center;
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		text-transform: uppercase;
		text-align: center;
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		font-size: 17pt;
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		font-family: Oswald, Arimo, sans-serif;
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		background-position: right bottom;
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		font-size: 20pt;
		text-align: left;
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	.indexsection .read-more_link {
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		width: 15%;
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	.indexsection .custom_message {
		padding: 25px;
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	.indexsection .message {
		padding: 20px 0;
		text-align: left;
		font-family: Montserrat, sans-serif !important;
		color: #000;
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	.indexsectionImg img {
		width: 40%;
		float: right;
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	.custom-mini-banner .banner-box {
		display: inline-block;
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	.custom-mini-banner {
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		font-family: Montserrat, sans-serif;
		text-transform: uppercase;
		padding-left: 100px;
		padding-right: 100px;
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	.custom-mini-banner .mini-banner-1,
	.custom-mini-banner .mini-banner-2 {
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		vertical-align: middle;
		text-align: left;
		box-sizing: border-box;
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	.custom-mini-banner .banner-box .title {
		font-weight: 700;
		display: inline-block;
		font-size: 18px;
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	.custom-mini-banner .banner-box .desc {
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		line-height: 16px;
		padding-top: 6px;
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	.prepResource-title {
		font-size: 20pt;
		text-align: center;
		text-transform: uppercase;
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	.mobile div#chabad_head .chabad_navigator_bar ul li {
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	/* End of desktop CSS */

	/* Start of Media Queries */

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		#co_calendar .item {
			min-height: 175px;
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		.co_calendar_text {
			padding-left: 52px;
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		#co_calendar .item.large-width {
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		.co_calendar_text {
			padding-left: 52px;
			padding-right: 52px;
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		.co_calendar_text {
			padding-left: 62px;
			padding-right: 62px;
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			padding-right: 52px;
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		.co_calendar_text {
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			padding-right: 62px;
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			justify-content: center;
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	@media only screen and (max-width: 650px) {
		.bannerCta,
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			display: none;
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		.co_photo_gallery_head,
		.textWrapper span {
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		.textWrapper {
			background: rgba(255, 255, 255, 0.75);
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		.textWrapper .big {
			color: #000;
			margin: 0;
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			padding-top: 10px;
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		.chabad_header {
			background-image: none;
			height: 250px;
			display: block !important;
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		.chabad_header img {
			background-size: cover;
			background-position: center 0;
			background-attachment: inherit;
			height: 250px;
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		.headerTitle {
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		.headerSubTitle,
		.header-desc {
			font-size: 20pt;
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		.header-desc {
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		div#chabad_head .chabad_navigator_bar ul li a {
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			line-height: 45px;
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		body.mobile #navigation.chabad_navigator_bar #menu {
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			height: 45px;
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		body.mobile .g960.footer {
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		.textWrapper {
			padding: 5px;
			float: none;
			left: 0;
			height: auto !important;
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		.sPromo-wrap {
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		.small_promos img {
			width: 75%;
			display: initial;
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		.custom_message .title {
			font-size: 25pt;
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		.custom_message .message {
			width: 100%;
			font-size: 13pt;
			padding: 10px;
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		#co_calendar {
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		#co_calendar .item {
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			width: 100% !important;
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			width: 45%;
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		.textWrapper {
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		.custom-mini-banner .banner-box {
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			width: 100%;
			padding: 10px;
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		.custom-mini-banner {
			padding-left: 0px;
			padding-right: 0px;
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		#co_calendar .item .calendar-width,
		.calendar-width {
			max-width: 936px;
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		#co_calendar .item .normal-width {
			width: 300px;
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		#co_calendar .item .normal-width.last {
			width: 600px;
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		#co_calendar .item.medium-width,
		#co_calendar .item.small-width {
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		#co_calendar .item.normal-width {
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		#co_calendar .item.large-width {
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		div#chabad_body_content {
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		body.mobile #navigation.chabad_navigator_bar #menu li:not(.heading) {
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		div#chabad_head .chabad_navigator_bar ul li a {
			border-right: 0 !important;
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		body.cco_templateless_page.mobile #navigation.chabad_navigator_bar #menu {
			margin-top: 10px;
			height: 45px;
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		body.mobile .chabad_navigator_bar .sub_menu_toggle {
			background: url(https://w2.chabad.org/images/shluchim/minisites/down_triangle_white.gif) no-repeat center;
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		body.mobile div.chabad_navigator_bar #menu .sub_menu ul {
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		body.mobile #navigation.chabad_navigator_bar #menu li:not(.heading) {
			padding-left: 0;
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		div#chabad_head .chabad_navigator_bar ul li ul li {
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		body.mobile #navigation.chabad_navigator_bar #menu {
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		/*.cco_templateless_page #chabad_main_content {
			background-image: url(https://w2.chabad.org/images/Shluchim/minisites/themes/Generic_New/abstract2.jpg);
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			background-size: contain;
			background-color: rgba(255, 255, 255, 0.7);
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		.bannerCta button {
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		.small_promos {
			margin-top: 10px;
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		.co_features {
			width: 25%;
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		.co_photo_gallery_head {
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		.g960.footer {
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<div id="chabad_body_page">
<div id="chabad_main_content">
<div id="chabad_head">


<div class="chabad_header">

<img src="https://w2.chabad.org/media/images/1318/KwbX13180682.png" alt="Welcome!" />
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<a href="/5117373" style="text-decoration: none;">
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<div class="headerSubTitle">
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</div>


<div id="navigation" class="chabad_navigator_bar">
<div class="chabad_menu_content">
<ul id="menu" class="navi">
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<a href="/article.asp?aid=6439965" class="parent selected">Reservations & Greetings</a>
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</ul>
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<header class="article-header cf ">
	
	
			<h1 class="article-header__title js-article-title js-page-title">Reservations & Greetings</h1>
		
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			<div class="body_wrapper clearfix co_body">
				<div class="" id="co_body_container">
					
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<div id="formContainer"><script type="text/javascript">var defaultCurrency = { value: 'USD', symbol: '$'};
$j(function(){
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window.formJson = Object.extend([{"form_height":450,"56_text":"\u003cp\u003eWelcome to the 2025 Cteen Gala, our beloved annual fundraiser! This is the page to sponsor greetings, and to reserve your attendance.\u0026#160;\u003c/p\u003e\n","56_name":"doubleclickTo56","56_qid":56,"56_type":"control_text","56_order":1,"67_text":"","67_message":"","67_labelAlign":"Auto","67_required":"No","67_options":"We are reserving for the Gala, without journal greetings|We are reserving for the Gala, and would like to include journal greetings|We are placing a greeting in the journal, but regretfully we will not attend.","67_special":"None","67_allowOther":"No","67_otherText":"Other","67_calculateOther":"No","67_selected":"","67_spreadCols":"1","67_description":"","67_name":"input67","67_qid":67,"67_type":"control_radio","67_order":2,"24_text":"Journal Greetings:","24_message":"","24_labelAlign":"Top","24_required":"No","24_options":"$5,000 - Orchid + Sponsor a table for Teens|$2,000 - Rose (includes 2 reservations)|$1,200 - Peony (includes 2 reservations)|$600 - Daisy (Includes 2 reservations)|$360 - Tulip (Includes 1 reservation)|$200 - Carnation","24_special":"None","24_allowOther":"No","24_otherText":"Other","24_calculateOther":"No","24_selected":"$360 - Tulip (Includes 1 reservation)","24_spreadCols":"1","24_description":"","24_name":"journalGreetings24","24_qid":24,"24_type":"control_radio","24_order":3,"24_pricing":"5000|2000|1200|600|360|200","24_shrink":"Yes","28_text":"My greeting is in honor of:","28_message":"","28_labelAlign":"Top","28_required":"No","28_options":"Nathan Bershadsky|Ori Mor|Temima Soffer|Shoshi Cantz|Caley Gordon|Shira Thompson|Rabbi Yochanan and Yona Posner|Jake and Rachel Jakofsky|David and Tami Miller|Avi and Shoshy Mor|Ike and Carolyn Soffer|Ralph and Marina Bershadsky","28_special":"None","28_allowOther":"Yes","28_otherText":"Other","28_calculateOther":"No","28_selected":"","28_spreadCols":"1","28_description":"","28_name":"myGreeting","28_qid":28,"28_type":"control_radio","28_order":4,"28_shrink":"Yes","28_pricing":"0|0|0|0|0|0|0|0|0|0|0|0","29_text":"Greeting text","29_message":"","29_labelAlign":"Auto","29_required":"No","29_cols":40,"29_rows":6,"29_validation":"None","29_entryLimit":"None-0","29_maxsize":"","29_defaultValue":"","29_subLabel":"Artwork can be submitted to info@SkokieCteen.org","29_hint":"","29_description":"","29_readonly":"No","29_wysiwyg":"Disable","29_name":"greetingText","29_qid":29,"29_type":"control_textarea","29_order":5,"29_shrink":"No","51_text":"\u003cp\u003e\u003cstrong\u003eDinner Reservations:\u003c/strong\u003e\u003c/p\u003e","51_name":"doubleclickTo51","51_qid":51,"51_type":"control_text","51_order":6,"65_text":"Your greeting includes 2 reservations, please enter those names here. If you\u0027d like to include more reservations, select number of adults and teens below.","65_message":"","65_labelAlign":"Auto","65_required":"No","65_cols":40,"65_rows":6,"65_validation":"None","65_entryLimit":"None-0","65_maxsize":"","65_defaultValue":"","65_subLabel":"We will try to accommodate seating requests, if possible. Enter requests here with names.","65_hint":"","65_description":"","65_readonly":"No","65_wysiwyg":"Disable","65_name":"pleaseEnter65","65_qid":65,"65_type":"control_textarea","65_order":7,"68_text":"Your greeting includes 1 reservations, please enter those names here. If you\u0027d like to include more reservations, select number of adults and teens below.","68_message":"","68_labelAlign":"Auto","68_required":"No","68_cols":40,"68_rows":6,"68_validation":"None","68_entryLimit":"None-0","68_maxsize":"","68_defaultValue":"","68_subLabel":"We will try to accommodate seating requests, if possible. Enter requests here with names.","68_hint":"","68_description":"","68_readonly":"No","68_wysiwyg":"Disable","68_name":"pleaseEnter68","68_qid":68,"68_type":"control_textarea","68_order":8,"69_text":"Your greeting includes 10 reservations, please enter those names here. If you\u0027d like to include more reservations, select number of adults and teens below.","69_message":"","69_labelAlign":"Auto","69_required":"No","69_cols":40,"69_rows":6,"69_validation":"None","69_entryLimit":"None-0","69_maxsize":"","69_defaultValue":"","69_subLabel":"We will try to accommodate seating requests, if possible. 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<form class="userform-form" action="" method="post" name="form_6439965" id="6439965" accept-charset="utf-8"><input type="hidden" name="formID" value="6439965" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_56"><div id="cid_56" class="form-input-wide"> <div id="text_56" class="form-html"><p>Welcome to the 2025 Cteen Gala, our beloved annual fundraiser! This is the page to sponsor greetings, and to reserve your attendance. </p>
</div> </div></li><li class="form-line" id="id_67"><div class="form-label-top" id="label_67"><label for="input_67">  </label><label class="label-message" for="input_67"> </label></div><div id="cid_67" class="form-input-wide"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_67_0" name="q67_input67" value="We are reserving for the Gala, without journal greetings" /><label id="label_input_67_0" for="input_67_0"><span>We are reserving for the Gala, without journal greetings</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_67_1" name="q67_input67" value="We are reserving for the Gala, and would like to include journal greetings" /><label id="label_input_67_1" for="input_67_1"><span>We are reserving for the Gala, and would like to include journal greetings</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_67_2" name="q67_input67" value="We are placing a greeting in the journal, but regretfully we will not attend." /><label id="label_input_67_2" for="input_67_2"><span>We are placing a greeting in the journal, but regretfully we will not attend.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_24"><div class="form-label-top" id="label_24"><label for="input_24"> Journal Greetings: </label><label class="label-message" for="input_24"> </label></div><div id="cid_24" class="form-input-wide"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_24_0" name="q24_journalGreetings24" value="$5,000 - Orchid + Sponsor a table for Teens" /><label id="label_input_24_0" for="input_24_0"><span>$5,000 - Orchid + Sponsor a table for Teens</span></label></span><span class="clearfix"></span><span 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type="radio" class="form-radio" id="input_24_4" name="q24_journalGreetings24" checked="checked" value="$360 - Tulip (Includes 1 reservation)" /><label id="label_input_24_4" for="input_24_4"><span>$360 - Tulip (Includes 1 reservation)</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_24_5" name="q24_journalGreetings24" value="$200 - Carnation" /><label id="label_input_24_5" for="input_24_5"><span>$200 - Carnation</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_28"><div class="form-label-top" id="label_28"><label for="input_28"> My greeting is in honor of: </label><label class="label-message" for="input_28"> </label></div><div id="cid_28" class="form-input-wide"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_0" name="q28_myGreeting" value="Nathan Bershadsky" /><label id="label_input_28_0" for="input_28_0"><span>Nathan Bershadsky</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_1" name="q28_myGreeting" value="Ori Mor" /><label id="label_input_28_1" for="input_28_1"><span>Ori Mor</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_2" name="q28_myGreeting" value="Temima Soffer" /><label id="label_input_28_2" for="input_28_2"><span>Temima Soffer</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_3" name="q28_myGreeting" value="Shoshi Cantz" /><label id="label_input_28_3" for="input_28_3"><span>Shoshi Cantz</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_4" name="q28_myGreeting" value="Caley Gordon" /><label id="label_input_28_4" for="input_28_4"><span>Caley Gordon</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_5" name="q28_myGreeting" value="Shira Thompson" /><label id="label_input_28_5" for="input_28_5"><span>Shira Thompson</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_6" name="q28_myGreeting" value="Rabbi Yochanan and Yona Posner" /><label id="label_input_28_6" for="input_28_6"><span>Rabbi Yochanan and Yona Posner</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_7" name="q28_myGreeting" value="Jake and Rachel Jakofsky" /><label id="label_input_28_7" for="input_28_7"><span>Jake and Rachel Jakofsky</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_8" name="q28_myGreeting" value="David and Tami Miller" /><label id="label_input_28_8" for="input_28_8"><span>David and Tami Miller</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_9" name="q28_myGreeting" value="Avi and Shoshy Mor" /><label id="label_input_28_9" for="input_28_9"><span>Avi and Shoshy Mor</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_10" name="q28_myGreeting" value="Ike and Carolyn Soffer" /><label id="label_input_28_10" for="input_28_10"><span>Ike and Carolyn Soffer</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_28_11" name="q28_myGreeting" value="Ralph and Marina Bershadsky" /><label 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class="form-line" id="id_51"><div id="cid_51" class="form-input-wide"> <div id="text_51" class="form-html"><p><strong>Dinner Reservations:</strong></p></div> </div></li><li class="form-line" id="id_65"><div class="form-label-top" id="label_65"><label for="input_65"> Your greeting includes 2 reservations, please enter those names here. If you'd like to include more reservations, select number of adults and teens below. </label><label class="label-message" for="input_65"> </label></div><div id="cid_65" class="form-input-wide"> <span class="form-sub-label-container"><textarea id="input_65" class="form-textarea" name="q65_pleaseEnter65" cols="40" rows="6"></textarea>  <label class="form-sub-label" for="input_65">We will try to accommodate seating requests, if possible. Enter requests here with names.</label></span> </div></li><li class="form-line" id="id_68"><div class="form-label-top" id="label_68"><label for="input_68"> Your greeting includes 1 reservations, please enter those names here. If you'd like to include more reservations, select number of adults and teens below. </label><label class="label-message" for="input_68"> </label></div><div id="cid_68" class="form-input-wide"> <span class="form-sub-label-container"><textarea id="input_68" class="form-textarea" name="q68_pleaseEnter68" cols="40" rows="6"></textarea>  <label class="form-sub-label" for="input_68">We will try to accommodate seating requests, if possible. Enter requests here with names.</label></span> </div></li><li class="form-line" id="id_69"><div class="form-label-top" id="label_69"><label for="input_69"> Your greeting includes 10 reservations, please enter those names here. If you'd like to include more reservations, select number of adults and teens below. </label><label class="label-message" for="input_69"> </label></div><div id="cid_69" class="form-input-wide"> <span class="form-sub-label-container"><textarea id="input_69" class="form-textarea" name="q69_pleaseEnter69" cols="40" rows="6"></textarea>  <label class="form-sub-label" for="input_69">We will try to accommodate seating requests, if possible. Enter requests here with names.</label></span> </div></li><li class="form-line" id="id_49"><div class="form-label-top" id="label_49"><label for="input_49"> Adult ($115) </label><label class="label-message" for="input_49"> </label></div><div id="cid_49" class="form-input-wide"> <input type="number" class="form-number-input  form-textbox" id="input_49" name="q49_adult65" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" max="15" data-numbermax="15" /> </div></li><li class="form-line" id="id_57"><div class="form-label-top" id="label_57"><label for="input_57"> Please enter names of adults  here: </label><label class="label-message" for="input_57"> </label></div><div id="cid_57" class="form-input-wide"> <span class="form-sub-label-container"><textarea id="input_57" class="form-textarea" name="q57_pleaseEnter57" cols="40" rows="6"></textarea>  <label class="form-sub-label" for="input_57">We will try to accommodate seating requests, if possible. Enter requests here with names.</label></span> </div></li><li class="form-line" id="id_50"><div class="form-label-top" id="label_50"><label for="input_50"> Teen ($72) </label><label class="label-message" for="input_50"> </label></div><div id="cid_50" class="form-input-wide"> <input type="number" class="form-number-input  form-textbox" id="input_50" name="q50_teen35" style="width:60px" size="5" value="Please select" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" max="15" data-numbermax="15" /> </div></li><li class="form-line" id="id_46"><div class="form-label-top" id="label_46"><label for="input_46"> Please enter names of teens  here: </label><label class="label-message" for="input_46"> </label></div><div id="cid_46" class="form-input-wide"> <span class="form-sub-label-container"><textarea id="input_46" class="form-textarea" name="q46_pleaseEnter46" cols="40" rows="6"></textarea>  <label class="form-sub-label" for="input_46">We will try to accommodate seating requests, if possible. In general Cteeners (highschool age) are seated with their peers,<br /> unless requested otherwise. Cteen Juniors (middle school age) are seated with their parents, if their parents are not coming <br /> they are seated with their peers,  unless requested otherwise.</label></span> </div></li><li class="form-line" id="id_61"><div class="form-label-top" id="label_61"><label for="input_61"> Optional Teen Greeting </label><label class="label-message" for="input_61"> The special Teen Greeting is for teens to sponsor a short greeting of just one line for just $18.</label></div><div id="cid_61" class="form-input-wide"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_61_0" name="q61_input61[]" value="Please include a 1-line greeting for my teen ($18)" /><label id="label_input_61_0" for="input_61_0"><span>Please include a 1-line greeting for my teen ($18)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_63"><div class="form-label-top" id="label_63"><label for="input_63"> Text for teen greeting: </label><label class="label-message" for="input_63"> </label></div><div id="cid_63" class="form-input-wide"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_63" name="q63_input63" size="20" value="" /> </div></li><li class="form-line" id="id_64"><div class="form-label-top" id="label_64"><label for="input_64"> Dietary requests will be accommodated if possible. Please enter here. </label><label class="label-message" for="input_64"> </label></div><div id="cid_64" class="form-input-wide"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_64" name="q64_input64" size="20" value="" /> </div></li><li class="form-line" id="id_26"><div class="form-label-top" id="label_26"><label for="input_26"> We are giving a donation in support of Skokie Cteen. </label><label class="label-message" for="input_26">     </label></div><div id="cid_26" class="form-input-wide"> <div class="form-single-column"><span class="form-radio-item simple-mode"><label id="label_input_26" for="input_26"><span>$</span></label><input type="number" class="form-textbox" id="input_26" name="q26_weAre26" value="" onkeypress="validateNumber(event)" /></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_17"><div class="form-label-top" id="label_17"><label for="input_17"> Total </label></div><div id="cid_17" class="form-input-wide"> <div id="total_amount">$0.00 </div><div class="form-single-column form-checkbox-item" id="div_offset_gift_17" style="padding-top: 10px">		<input type="checkbox" id="input_17" class="form-checkbox" name="q17_offsetGiftPercent" value="3" />		<label id="label_17" for="input_17">Yes, I'd like to donate the cost of processing this transaction by adding 3%</label>        <input type="hidden" id="hidden_17" name="q17_offsetGiftAmount" />		<div class="clearfix"></div>        </div> </div></li><li class="form-line" id="id_15"><div class="form-label-top" id="label_15"><label for="input_15"> Payment<span class="form-required">*</span> </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" 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"></td></tr><tr class="credit_card "><th colspan="2">Credit Card</th></tr><tr class="credit_card "><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="q15_payment[cc_type]" id="input_15_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[required, visible, creditcard]" type="text" name="q15_payment[cc_number]" id="input_15_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_15_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[required, visible]" type="text" name="q15_payment[cc_ccv]" id="input_15_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_15_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[required, visible]" type="text" name="q15_payment[cc_nameOnCard]" id="input_15_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_15_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card "><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[required, visible]" name="q15_payment[cc_exp_month]" id="input_15_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_15_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[required, visible]" name="q15_payment[cc_exp_year]" id="input_15_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 value="2034">2034</option></select>  <label class="form-sub-label" for="input_15_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="billing_address "><th colspan="2">Billing Address</th></tr><tr class="billing_address "><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q15_payment[addr_line1]" id="input_15_addr_line1" autocomplete="billing address-line1" />  <label class="form-sub-label" for="input_15_addr_line1" id="sublabel_15_addr_line1">Street Address</label></span></td></tr><tr class="billing_address "><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-city" type="text" name="q15_payment[city]" id="input_15_city" autocomplete="billing address-level2" />  <label class="form-sub-label" for="input_15_city" id="sublabel_15_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q15_payment[state]" id="input_15_state" autocomplete="billing address-level1" />  <label class="form-sub-label" for="input_15_state" id="sublabel_15_state">State / Province</label></span></td></tr><tr class="billing_address "><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-postal" type="text" name="q15_payment[postal]" id="input_15_postal" size="10" autocomplete="billing postal-code" />  <label class="form-sub-label" for="input_15_postal" id="sublabel_15_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q15_payment[country]" id="input_15_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 value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_15_country" id="sublabel_15_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_34"><div class="form-label-top" id="label_34"><label for="input_34"> Phone Number<span class="form-required">*</span> </label><label 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