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	Yizkor - Chabad of Southlake
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			<h1 class="article-header__title js-article-title js-page-title">Yizkor</h1>
		
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<form class="userform-form" action="" method="post" name="form_3433220" id="3433220" accept-charset="utf-8"><input type="hidden" name="formID" value="3433220" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_15"><div id="cid_15" class="form-input-wide"> <div style="text-align:center;"><img alt="" class="form-image" border="0" src="https://w2.chabad.org/media/images/1380/ocIm13800231.png" height="425" width="810" /></div> </div></li><li class="form-line" id="id_13"><div id="cid_13" class="form-input-wide"> <div id="text_13" class="form-html"><p style="text-align: justify;"><span style="line-height:2;"><span style="font-size:18px;">This year in honor of Yom Kippur we are once again putting together a listing of all the names of our loved ones to be remembered during Yizkor at Chabad of Southlake (Arlington). </span></span></p>

<p style="text-align: justify;"><span style="line-height:2;"><span style="font-size:18px;">Having all these names compiled in one booklet, as is customary in many communities, brings everyone together as one family and brings an added measure of dignity and merit to the souls of our loved ones. Even if you will not be attending in person it is a beautiful commemoration to our loved ones for them to be mentioned. </span></span></p>

<p style="text-align: justify;"><span style="line-height:2;"><span style="font-size:18px;">Please fill in the names of your departed loved ones into the form below. A contribution of $18 per name is requested.</span></span></p>
</div> </div></li><li class="form-line" id="id_1"><div class="form-label-top" id="label_1"><label for="input_1"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_1"> </label></div><div id="cid_1" class="form-input-wide"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q1_fullName[first]" id="first_1" autocomplete="given-name" />  <label class="form-sub-label" for="first_1" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q1_fullName[last]" id="last_1" autocomplete="family-name" />  <label class="form-sub-label" for="last_1" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_3"><div class="form-label-top" id="label_3"><label for="input_3"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_3"> </label></div><div id="cid_3" class="form-input-wide"> <input type="email" class=" form-textbox validate[required, Email]" id="input_3" name="q3_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_6"><div class="form-label-top" id="label_6"><label for="input_6"> Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_6"> </label></div><div id="cid_6" class="form-input-wide"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q6_phoneNumber[area]" id="input_6_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_6_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q6_phoneNumber[phone]" id="input_6_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_6_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_11"><div class="form-label-top" id="label_11"><label for="input_11"> Number of Names<span class="form-required">*</span> </label><label class="label-message" for="input_11"> $18 Per Name</label></div><div id="cid_11" class="form-input-wide"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_11" name="q11_numberOf" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="1" data-numbermin="1" /> </div></li><li class="form-line" id="id_8"><div class="form-label-top" id="label_8"><label for="input_8"> Yizkor Information<span class="form-required">*</span> </label><label class="label-message" for="input_8"> One Name Per Line</label></div><div id="cid_8" class="form-input-wide"> <textarea id="input_8" class="form-textarea validate[required]" name="q8_yizkorInformation" cols="80" rows="6"></textarea> </div></li><li class="form-line" id="id_16"><div class="form-label-top" id="label_16"><label for="input_16"> Yes! I would also like to contribute to the High Holiday Appeal in memory of my loved one/s </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input-wide"> <div class="form-single-column"><span class="form-radio-item simple-mode"><label id="label_input_16" for="input_16"><span>$</span></label><input type="number" class="form-textbox" id="input_16" name="q16_input16" value="" onkeypress="validateNumber(event)" /></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_14"><div id="cid_14" class="form-input-wide"> <div id="text_14" class="form-html"><p><span style="font-size:18px;"><a href="http://www.JewishSouthLake.com/Article.asp?AID=5592501">Click Here</a> to dedicate a plaque on our Memorial Board in memory of your loved one/s </span></p>
</div> </div></li><li class="form-line" id="id_12"><div class="form-label-top" id="label_12"><label for="input_12"> Total </label></div><div id="cid_12" class="form-input-wide"> <div id="total_amount">$0.00 </div><div class="form-single-column form-checkbox-item" id="div_offset_gift_12" style="padding-top: 10px">            <input type="checkbox" id="input_12" class="form-checkbox" name="q12_offsetGiftPercent" value="3" />            <label id="label_12" for="input_12">Yes, I'd like to donate the cost of processing this transaction by adding 3%</label>                <input type="hidden" id="hidden_12" name="q12_offsetGiftAmount" />              <div class="clearfix"></div>            </div> </div></li><li class="form-line" id="id_10"><div class="form-label-top" id="label_10"><label for="input_10"> Payment<span class="form-required">*</span> </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input-wide"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"><span class="form-radio-item"><input class="paymentMethod form-radio validate[required, paymentMethod] form-radio" type="radio" id="input_10_creditCard" name="q10_payment[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_10_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[required, paymentMethod] form-radio" type="radio" id="input_10_other" name="q10_payment[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_10_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="q10_payment[cc_type]" id="input_10_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="q10_payment[cc_number]" id="input_10_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_10_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="q10_payment[cc_ccv]" id="input_10_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_10_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="q10_payment[cc_nameOnCard]" id="input_10_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_10_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[required, visible]" name="q10_payment[cc_exp_month]" id="input_10_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_10_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="q10_payment[cc_exp_year]" id="input_10_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_10_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="other hide"><td colspan="2">Please make checks payable to:<br />Chabad of Southlake. <br />1970 E Dove Rd. <br />Southlake, TX 76092<br />For Zelle, Paypal, Venmo &amp; Cashapp the address is: rabbi@jewishsouthlake.com</td></tr><tr class="billing_address hide"><th colspan="2">Billing Address</th></tr><tr class="billing_address hide"><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q10_payment[addr_line1]" id="input_10_addr_line1" autocomplete="billing address-line1" />  <label class="form-sub-label" for="input_10_addr_line1" id="sublabel_10_addr_line1">Street Address</label></span></td></tr><tr class="billing_address hide"><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-city" type="text" name="q10_payment[city]" id="input_10_city" autocomplete="billing address-level2" />  <label class="form-sub-label" for="input_10_city" id="sublabel_10_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q10_payment[state]" id="input_10_state" autocomplete="billing address-level1" />  <label class="form-sub-label" for="input_10_state" id="sublabel_10_state">State / Province</label></span></td></tr><tr class="billing_address hide"><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-postal" type="text" name="q10_payment[postal]" id="input_10_postal" size="10" autocomplete="billing postal-code" />  <label class="form-sub-label" for="input_10_postal" id="sublabel_10_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q10_payment[country]" id="input_10_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 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		<span class="footer-title" >Chabad of Southlake</span>
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			<span class="footer-street">1970 E Dove Road </span>
			<span class="footer-city-state">Southlake, TX 76092</span>
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