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<form class="userform-form" action="" method="post" name="form_6648668" id="6648668" accept-charset="utf-8"><input type="hidden" name="formID" value="6648668" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_1"><div id="cid_1" class="form-input-wide"> <div style="text-align:center;"><img alt="" class="form-image" border="0" src="https://w2.chabad.org/media/images/1296/qfwU12966543.png" height="340" width="940" /></div> </div></li><li class="form-line" id="id_2"><div id="cid_2" class="form-input-wide"> <div id="text_2" class="form-html"><h3 style="text-align: center;"><strong>Celebrating 50 Years of Capital Region Chabad and honoring its founders:<br />
Rabbi Israel and Rochel Rubin</strong></h3>

<p style="text-align: center;"><strong>Sunday, December 8th, 2024</strong><br />
between Torah portions of Vayeitze &amp; Vayishlach<br />
1:30pm at Shabbos House 320 Fuller Road</p>

<p style="text-align: center;">Elegant Buffet Reception <br />
Reflections of Five Decades of Dedication</p>

<p style="text-align: center;"><strong>Couvert $50pp</strong></p>

<p style="text-align: center;">Parking at UAlbany’s Dutch Gold Lot<br />
Parking Shuttle Available</p>

<p style="text-align: center;">Commemorative Souvenir Journal<br />
Tribute Greetings $50<br />
Decade Sponsorships:<br />
1 Decade Sponsor $360<br />
2 Decades Sponsor $540<br />
3 Decades Sponsor $1080<br />
4 Decades Sponsor $1800<br />
5 Decades Sponsor $3600<br />
 </p>
</div> </div></li><li class="form-line" id="id_3"><div class="form-label-left" id="label_3"><label for="input_3"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_3"> </label></div><div id="cid_3" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q3_fullName[first]" id="first_3" autocomplete="given-name" />  <label class="form-sub-label" for="first_3" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q3_fullName[last]" id="last_3" autocomplete="family-name" />  <label class="form-sub-label" for="last_3" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_4"><div class="form-label-left" id="label_4"><label for="input_4"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_4"> </label></div><div id="cid_4" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_4" name="q4_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input data-type="mask-number" class="mask-phone-number form-textbox validate[required]" type="tel" name="q5_phoneNumber[full]" id="input_5_full" autocomplete="tel" />  <label class="form-sub-label" for="input_5_full"><span> </span></label></span></div> </div></li><li class="form-line" id="id_21"><div class="form-label-left" id="label_21"><label for="input_21"> Couvert: </label><label class="label-message" for="input_21"> </label></div><div id="cid_21" class="form-input"> <select class="form-dropdown" style="width:150px" id="input_21" name="q21_input21"><option value=""></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option></select> </div></li><li class="form-line" id="id_16"><div class="form-label-left" id="label_16"><label for="input_16"> Attendee #2 </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q16_fullName16[first]" id="first_16" autocomplete="given-name" />  <label class="form-sub-label" for="first_16" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q16_fullName16[last]" id="last_16" autocomplete="family-name" />  <label class="form-sub-label" for="last_16" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> Attendee #3 </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q17_fullName17[first]" id="first_17" autocomplete="given-name" />  <label class="form-sub-label" for="first_17" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q17_fullName17[last]" id="last_17" autocomplete="family-name" />  <label class="form-sub-label" for="last_17" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Attendee #4 </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q18_fullName18[first]" id="first_18" autocomplete="given-name" />  <label class="form-sub-label" for="first_18" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q18_fullName18[last]" id="last_18" autocomplete="family-name" />  <label class="form-sub-label" for="last_18" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> Attendee #5 </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q19_fullName19[first]" id="first_19" autocomplete="given-name" />  <label class="form-sub-label" for="first_19" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q19_fullName19[last]" id="last_19" autocomplete="family-name" />  <label class="form-sub-label" for="last_19" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_14"><div class="form-label-left" id="label_14"><label for="input_14"> Tribute Greeting Cost: </label><label class="label-message" for="input_14"> </label></div><div id="cid_14" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_14_0" name="q14_input14[]" value="$50" /><label id="label_input_14_0" for="input_14_0"><span>$50</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_20"><div class="form-label-left" id="label_20"><label for="input_20"> Tribute Greeting: </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_20" name="q20_input20" size="20" value="" /> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Decade Sponsorships: </label><label class="label-message" for="input_9"> Inclusive of two (2) tickets</label></div><div id="cid_9" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_9_0" name="q9_input9" value="1 Decade Sponsor - $360" /><label id="label_input_9_0" for="input_9_0"><span>1 Decade Sponsor - $360</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_9_1" name="q9_input9" value="2 Decades Sponsor - $540" /><label id="label_input_9_1" for="input_9_1"><span>2 Decades Sponsor - $540</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_9_2" name="q9_input9" value="3 Decades Sponsor - $1080" /><label id="label_input_9_2" for="input_9_2"><span>3 Decades Sponsor - $1080</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_9_3" name="q9_input9" value="4 Decades Sponsor - $1800" /><label id="label_input_9_3" for="input_9_3"><span>4 Decades Sponsor - $1800</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_9_4" name="q9_input9" value="5 Decades Sponsor - $3600" /><label id="label_input_9_4" for="input_9_4"><span>5 Decades Sponsor - $3600</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_22"><div class="form-label-left" id="label_22"><label for="input_22"> Dedication/s: </label><label class="label-message" for="input_22"> </label></div><div id="cid_22" class="form-input"> <input type="text" 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