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	Chanukah on Main St. - Chabad of Bradenton
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			<h1 class="article-header__title js-article-title js-page-title">Chanukah on Main St.</h1>
		
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window.formJson = Object.extend([{"form_height":493,"25_text":"\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 16px;\"\u003eScroll down to RSVP!\u003c/span\u003e\u003cspan style=\"\"\u003e\u003c/span\u003e\u003c/p\u003e","25_name":"doubleclickTo25","25_qid":25,"25_type":"control_text","25_order":1,"26_text":"Image","26_message":"","26_src":"https://w2.chabad.org/media/images/1339/ytUC13391075.jpg","26_link":"","26_target":"_blank","26_height":1043,"26_width":745,"26_align":"Center","26_description":"","26_name":"image","26_qid":26,"26_type":"control_image","26_order":2,"24_text":"\u003cp style=\"text-align: center;\"\u003eChabad of\u0026#160;Bradenton\u0026#160;\u0026amp; Lakewood Ranch\u0026#160;\u003cbr\u003e\nPresents\u003cbr\u003e\n\u003cstrong\u003e\u003cspan style=\"font-size: 22px;\"\u003eChanukah on Main Street\u0026#160;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 22px;\"\u003eThursday, December 26th at 6 pm\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 14px;\"\u003eLakewood Ranch Main Street\u003cbr\u003e\n\u003cbr\u003e\n\u0026#160;Join Chabad of\u0026#160;Bradenton\u0026#160;\u0026amp; Lakewood Ranch for\u0026#160;a\u0026#160;Chanukah Celebration featuring\u003cbr\u003e\nWorld Renowned Israeli Singer and Entertainer Yoel Sharabi\u003cbr\u003e\n\u003cbr\u003e\nLive Music, Latke Bar, Raffles, Face Painting, Balloon Sculpting, Doughnut Decorating, Judah The Maccabee, Dreidel Moonbounce, Fire Juggler, Falafel with Yoav, Kosher BBQ, Kona Ice Truck, Chanukah Art, Dreidel Mascot.\u003cbr\u003e\n\u003cbr\u003e\nAdmission is free.\u0026#160; Nominal food fees to apply.\u0026#160; Sponsor $500-$1800.\u003cbr\u003e\n\u003cbr\u003e\nThis event is sponsored\u0026#160;by Lakewood Ranch Main Street.\u0026#160;\u003c/span\u003e\u003c/p\u003e\n","24_name":"doubleclickTo24","24_qid":24,"24_type":"control_text","24_order":3,"24_hidden":"Yes","17_text":"Your Information","17_subHeader":"","17_headerType":"Default","17_name":"clickTo17","17_qid":17,"17_type":"control_head","17_order":4,"1_text":"Full Name:","1_message":"","1_labelAlign":"Auto","1_required":"Yes","1_prefix":"No","1_suffix":"No","1_middle":"No","1_description":"","1_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"1_readonly":"No","1_name":"fullName","1_qid":1,"1_type":"control_fullname","1_order":5,"3_receivesReceipts":"Yes","3_text":"E-mail:","3_message":"","3_labelAlign":"Auto","3_required":"Yes","3_size":30,"3_validation":"Email","3_maxsize":"","3_defaultValue":"","3_subLabel":"","3_hint":"ex: myname@example.com","3_description":"","3_confirmation":"No","3_confirmationHint":"Confirm Email","3_readonly":"No","3_name":"email","3_qid":3,"3_type":"control_email","3_order":6,"18_text":"Address","18_message":"","18_labelAlign":"Auto","18_required":"Yes","18_selectedCountry":"","18_description":"","18_subfields":"st1|city|state|zip","18_sublabels":{"cc_firstName":"First Name","cc_lastName":"Last Name","cc_number":"Credit Card Number","cc_ccv":"Security Code","cc_exp_month":"Expiration Month","cc_exp_year":"Expiration Year","addr_line1":"Street Address","addr_line2":"Street Address Line 2","city":"City","state":"State / Province","postal":"Postal / Zip Code","country":"Country"},"18_name":"address","18_qid":18,"18_type":"control_address","18_order":7,"22_text":"Community Name:","22_message":"","22_labelAlign":"Auto","22_required":"Yes","22_size":20,"22_validation":"None","22_maxsize":"","22_inputTextMask":"","22_defaultValue":"","22_subLabel":"ie Country Club, Lakewood National","22_hint":" ","22_description":"","22_readonly":"No","22_name":"input22","22_qid":22,"22_type":"control_textbox","22_order":8,"5_text":"Phone Number:","5_message":"","5_labelAlign":"Auto","5_required":"Yes","5_validation":"Numeric","5_countryCode":"No","5_inputMask":"disable","5_inputMaskValue":"(###) ###-####","5_description":"","5_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"5_readonly":"No","5_name":"phoneNumber5","5_qid":5,"5_type":"control_phone","5_order":9,"19_text":"Number of adult attendees:","19_message":"","19_labelAlign":"Auto","19_required":"Yes","19_size":5,"19_maxsize":"","19_minValue":"","19_maxValue":"","19_defaultValue":"","19_subLabel":"","19_hint":"ex: 2","19_description":"","19_readonly":"No","19_pricePerItem":0,"19_name":"number","19_qid":19,"19_type":"control_number","19_order":10,"20_text":"Number of child attendees:","20_message":"","20_labelAlign":"Auto","20_required":"No","20_size":5,"20_maxsize":"","20_minValue":"","20_maxValue":"","20_defaultValue":"","20_subLabel":"","20_hint":"ex: 2","20_description":"","20_readonly":"No","20_pricePerItem":0,"20_name":"number20","20_qid":20,"20_type":"control_number","20_order":11,"10_text":"Optional Donation","10_subHeader":"","10_headerType":"Default","10_name":"clickTo10","10_qid":10,"10_type":"control_head","10_order":12,"15_text":"I would like to donate towards this event:","15_message":"","15_labelAlign":"Auto","15_required":"No","15_options":"36|54|180|360|500|1000|1800","15_special":"None","15_allowOther":"Yes","15_otherText":"Other","15_selected":"","15_spreadCols":"3","15_description":"","15_mode":"radio_buttons","15_name":"donationAmount","15_qid":15,"15_type":"control_amount","15_order":13,"13_text":"Sponsorship options:","13_message":"","13_labelAlign":"Top","13_required":"No","13_options":"I would like to sponsor this event for $500.|I would like to sponsor this event for $800.|I would like to sponsor this event for $1000.|I would like to sponsor this event for $1500.|I would like to sponsor this event for $1800.","13_special":"None","13_allowOther":"No","13_otherText":"Other","13_calculateOther":"No","13_spreadCols":"1","13_selected":"","13_minSelection":"","13_maxSelection":"","13_description":"","13_name":"input13","13_qid":13,"13_type":"control_checkbox","13_order":14,"13_pricing":"500|800|1000|1500|1800","13_hidden":"No","23_text":"\u003cp style=\"text-align: left;\"\u003eHere are some links you can click on to purchase directly and ship to Chabad at:\u003cbr\u003e 5712 Lorraine Road\u003cbr\u003e Bradenton, FL 34211\u0026#160;\u003c/p\u003e    \u003cp\u003e24 Backpacks - \u003ca href=\"https://www.backpacksusa.com/products/17-wholesale-bulk-backpacks-in-8-assorted-colors-wholesale-case-of-24-bookbags?gclid=CjwKCAjwzt6LBhBeEiwAbPGOgSWFbY_s2onA69f-IklcRghGf2Wf1BlMLn27E9zcClsowC5bJBXYChoCBkIQAvD_BwE\" target=\"_blank\"\u003eClick Here\u003c/a\u003e\u0026#160;\u003cbr\u003e6 Reusable Water Bottles - \u003ca href=\"https://www.amazon.com/Reusable-Leakproof-Plastic-Carrier-Cycling/dp/B085TRXPRJ/ref=sr_1_8?dchild=1\u0026amp;keywords=bulk%2Bwater%2Bbottles\u0026amp;qid=1635348746\u0026amp;qsid=133-5546166-7574133\u0026amp;sr=8-8\u0026amp;sres=B07B69LT5B%2CB096CJ4Z11%2CB07NVV16YT%2CB085TRXPRJ%2CB08XMQXGQC%2CB0936QBRTG%2CB097SDRNHM%2CB0971MVV68%2CB08XM4KSYQ%2CB08QV1SXPQ%2CB0993FDZHN%2CB0914Q7G4F%2CB079MDQZ2N%2CB076262M9N%2CB07QF4Q3CR%2CB073XPP9XM%2CB09C35TWPT%2CB0936T1Z5V%2CB0971LD8FH%2CB0991PBXKS\u0026amp;srpt=BOTTLE\u0026amp;th=1\" target=\"_blank\"\u003eClick Here\u003c/a\u003e\u0026#160;\u003cbr\u003e72 Children\u0027\u0027s Soft Toothbrushes - \u003ca href=\"https://www.amazon.com/Childrens-Toothbrushes-Assorted-Individually-Wrapped/dp/B07B3MZK36/ref=sr_1_8?dchild=1\u0026amp;keywords=kids+toothbrushes+bulk\u0026amp;qid=1635348873\u0026amp;qsid=133-5546166-7574133\u0026amp;sr=8-8\u0026amp;sres=B092TR11W1%2CB01LZ5XZ9D%2CB089B3Q78S%2CB07B3MZK36%2CB085731SF3%2CB08L6Y4PXQ%2CB082MTHR7T%2CB082Y6HY17%2CB08BJC1RKC%2CB013CSJZNO%2CB08273JDYC%2CB07T99PP3F%2CB073BLVZ2T%2CB09D2NHQRF%2CB09GYC3DB1%2CB07PV2XQF5%2CB089L8NP96%2CB08RNGNXTS%2CB09G6RPLT6%2CB09HQVZPMW\u0026amp;srpt=TOOTHBRUSH\" target=\"_blank\"\u003eClick Here\u003c/a\u003e\u003cbr\u003e12 Children\u0027s Toothpaste - \u003ca 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href=\"https://www.amazon.com/Sunscreen-Lotion-Packets-SPF30-PABA-free/dp/B00EDU8JG0/ref=sr_1_16?crid=AIDCTU2E7GRI\u0026amp;dchild=1\u0026amp;keywords=sunscreen+bulk\u0026amp;qid=1635349588\u0026amp;qsid=133-5546166-7574133\u0026amp;sprefix=sunscreen+bulk%2Caps%2C130\u0026amp;sr=8-16\u0026amp;sres=B002ZNJYRA%2CB00467BPC0%2CB074P8BS9B%2CB01MQXX9US%2CB004CDV7EY%2CB077D7L95C%2CB00K58Q39Y%2CB07KL5K96X%2CB074W8L151%2CB084R18M8L%2CB00EDU8JG0%2CB07WDQ4Y6Q%2CB078BC1NJ6%2CB0795SY3Q9%2CB086R2JQZH%2CB078BF2BGP%2CB087H5FFGK%2CB01G62TJNY%2CB08CFVM1TT%2CB08FW63P3B\u0026amp;srpt=SUNSCREEN\" target=\"_blank\"\u003eClick 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<form class="userform-form" action="" method="post" name="form_3486973" id="3486973" accept-charset="utf-8"><input type="hidden" name="formID" value="3486973" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_25"><div id="cid_25" class="form-input-wide"> <div id="text_25" class="form-html"><p style="text-align: center;"><span style="font-size: 16px;">Scroll down to RSVP!</span><span style=""></span></p></div> </div></li><li class="form-line" id="id_26"><div id="cid_26" class="form-input-wide"> <div style="text-align:center;"><img alt="" class="form-image" border="0" src="https://w2.chabad.org/media/images/1339/ytUC13391075.jpg" height="1043" width="745" /></div> </div></li><li class="form-line always-hidden" id="id_24"><div id="cid_24" class="form-input-wide"> <div id="text_24" class="form-html"><p style="text-align: center;">Chabad of Bradenton &amp; Lakewood Ranch <br />
Presents<br />
<strong><span style="font-size: 22px;">Chanukah on Main Street </span></strong></p>

<p style="text-align: center;"><strong><span style="font-size: 22px;">Thursday, December 26th at 6 pm</span></strong></p>

<p style="text-align: center;"><span style="font-size: 14px;">Lakewood Ranch Main Street<br />
<br />
 Join Chabad of Bradenton &amp; Lakewood Ranch for a Chanukah Celebration featuring<br />
World Renowned Israeli Singer and Entertainer Yoel Sharabi<br />
<br />
Live Music, Latke Bar, Raffles, Face Painting, Balloon Sculpting, Doughnut Decorating, Judah The Maccabee, Dreidel Moonbounce, Fire Juggler, Falafel with Yoav, Kosher BBQ, Kona Ice Truck, Chanukah Art, Dreidel Mascot.<br />
<br />
Admission is free.  Nominal food fees to apply.  Sponsor $500-$1800.<br />
<br />
This event is sponsored by Lakewood Ranch Main Street. </span></p>
</div> </div></li><li id="cid_17" class="form-input-wide"> <div class="form-header-group"><h2 id="header_17" class="form-header">Your Information</h2></div> </li><li class="form-line" id="id_1"><div class="form-label-left" 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"> <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-left" 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"> <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_18"><div class="form-label-left" id="label_18"><label for="input_18"> Address<span class="form-required">*</span> </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q18_address[addr_line1]" id="input_18_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_18_addr_line1" id="sublabel_18_addr_line1">Street Address</label></span></td></tr><tr style="display: none;"><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q18_address[addr_line2]" id="input_18_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_18_addr_line2" id="sublabel_18_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-city" type="text" name="q18_address[city]" id="input_18_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_18_city" id="sublabel_18_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q18_address[state]" id="input_18_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_18_state" id="sublabel_18_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-postal" type="text" name="q18_address[postal]" id="input_18_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_18_postal" id="sublabel_18_postal">Postal / Zip Code</label></span></td><td style="display: none;"><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q18_address[country]" id="input_18_country" autocomplete="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_18_country" id="sublabel_18_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_22"><div class="form-label-left" id="label_22"><label for="input_22"> Community Name:<span class="form-required">*</span> </label><label class="label-message" for="input_22"> </label></div><div id="cid_22" class="form-input"> <span class="form-sub-label-container"><input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_22" name="q22_input22" size="20" value="" />  <label class="form-sub-label" for="input_22">ie Country Club, Lakewood National</label></span> </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 class="form-textbox validate[required, Numeric]" type="tel" name="q5_phoneNumber5[area]" id="input_5_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_5_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q5_phoneNumber5[phone]" id="input_5_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_5_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> Number of adult attendees:<span class="form-required">*</span> </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_19" name="q19_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_20"><div class="form-label-left" id="label_20"><label for="input_20"> Number of child attendees: </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_20" name="q20_number20" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li id="cid_10" class="form-input-wide"> <div class="form-header-group"><h2 id="header_10" class="form-header">Optional Donation</h2></div> </li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> I would like to donate towards this event: </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <div class="form-multiple-column" data-columns="3"><span class="form-radio-item"><input type="radio" class="form-radio" id="input_15_0" name="q15_donationAmount" value="36" /><label for="input_15_0"><span>$36</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_15_1" name="q15_donationAmount" value="54" /><label for="input_15_1"><span>$54</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_15_2" name="q15_donationAmount" value="180" /><label for="input_15_2"><span>$180</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_15_3" name="q15_donationAmount" value="360" /><label for="input_15_3"><span>$360</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_15_4" name="q15_donationAmount" value="500" /><label for="input_15_4"><span>$500</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_15_5" name="q15_donationAmount" value="1000" /><label for="input_15_5"><span>$1000</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_15_6" name="q15_donationAmount" value="1800" /><label for="input_15_6"><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="q15_donationAmount" id="other_15" value="" /><span><input type="number" min="1" class="form-radio-other-input form-textbox" onkeypress="validateNumber(event)" name="q15_donationAmount[other]" data-otherhint="Other" size="15" id="input_15" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_13"><div class="form-label-left" id="label_13"><label for="input_13"> Sponsorship options: </label><label class="label-message" for="input_13"> </label></div><div id="cid_13" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_13_0" name="q13_input13[]" value="I would like to sponsor this event for $500." /><label id="label_input_13_0" for="input_13_0"><span>I would like to sponsor this event for $500.</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_13_1" name="q13_input13[]" value="I would like to sponsor this event for $800." /><label id="label_input_13_1" for="input_13_1"><span>I would like to sponsor this event for $800.</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_13_2" name="q13_input13[]" value="I would like to sponsor this event for $1000." /><label id="label_input_13_2" for="input_13_2"><span>I would like to sponsor this event for $1000.</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_13_3" name="q13_input13[]" value="I would like to sponsor this event for $1500." /><label id="label_input_13_3" for="input_13_3"><span>I would like to sponsor this event for $1500.</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_13_4" name="q13_input13[]" value="I would like to sponsor this event for $1800." /><label id="label_input_13_4" for="input_13_4"><span>I would like to sponsor this event for $1800.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line always-hidden" id="id_23"><div id="cid_23" class="form-input-wide"> <div id="text_23" class="form-html"><p style="text-align: left;">Here are some links you can click on to purchase directly and ship to Chabad at:<br /> 5712 Lorraine Road<br /> Bradenton, FL 34211 </p>    <p>24 Backpacks - <a href="https://www.backpacksusa.com/products/17-wholesale-bulk-backpacks-in-8-assorted-colors-wholesale-case-of-24-bookbags?gclid=CjwKCAjwzt6LBhBeEiwAbPGOgSWFbY_s2onA69f-IklcRghGf2Wf1BlMLn27E9zcClsowC5bJBXYChoCBkIQAvD_BwE" target="_blank">Click Here</a> <br />6 Reusable Water Bottles - <a 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href="https://www.amazon.com/Medline-MedSpa-Roll-Antiperspirant-Case/dp/B002NH4ELE/ref=sr_1_7?crid=ZBSP7HNJF183&amp;dchild=1&amp;keywords=deodorant+bulk+for+homeless+100&amp;qid=1635349149&amp;qsid=133-5546166-7574133&amp;sprefix=deodoarant+bulk+%2Caps%2C117&amp;sr=8-7&amp;sres=B004JPLL7S%2CB003LM63KK%2CB002NH4ELE%2CB00A35SX4C%2CB01DJBE0B6%2CB07K7VG8L9%2CB07NCNRCMV%2CB07YGZ9HSL%2CB07YCW12MJ%2CB001ECQ4US%2CB003EH0CY0%2CB01DAR2EJE%2CB07CRR7PC5%2CB01JZOH9BO%2CB01DJBE6AQ%2CB01DME18KQ%2CB08HXGZ7LV%2CB083LDTH1C%2CB07CDMC6BG%2CB00GFF6896&amp;srpt=BODY_DEODORANT" target="_blank">Click Here</a><br />Scope Travel Size Mouthwash Classic Original Mint 1.2 Oz 48 Pack - <a href="https://www.amazon.com/Scope-Travel-Mouthwash-Classic-Original/dp/B01DAR2EJE/ref=sr_1_6?crid=1BLR39NP805CN&amp;dchild=1&amp;keywords=mouthwash+bulk&amp;qid=1635349253&amp;qsid=133-5546166-7574133&amp;sprefix=mouthwash%2Caps%2C128&amp;sr=8-6&amp;sres=B01DAR2EJE%2CB07CL7ZRC6%2CB07G358Y3T%2CB07J5TMSXB%2CB075YYXJ96%2CB07DVTMLK2%2CB08BW29DNJ%2CB07D6FSGX1%2CB07DM1FF59%2CB00EZWSBL4%2CB06XC4DSSW%2CB07J9W2QLP%2CB001F51QG6%2CB079XQYY8Z%2CB08MFWB9DY%2CB07C55H1QQ%2CB07TWZXRM4%2CB07H9XWL5Q%2CB07H9KY6MV%2CB097YWJWNN&amp;srpt=MOUTHWASH" target="_blank">Click Here</a><br />60 CHAP-LIP Lip Balm - <a href="https://www.amazon.com/Chap-Lip-Lip-Moisturizing-Soothing-Assorted/dp/B01LX97A0E/ref=sr_1_16?crid=39MBHLFW8168T&amp;dchild=1&amp;keywords=chapstick+in+bulk&amp;qid=1635349274&amp;qsid=133-5546166-7574133&amp;sprefix=chapstick%2Caps%2C125&amp;sr=8-16&amp;sres=B01IA9F2JQ%2CB013PSHZQ0%2CB07GVPQXRF%2CB08FTHLJ48%2CB07NX71WJY%2CB00LNCGP1M%2CB01INSE8GW%2CB07DC7HSCN%2CB07DCCLH96%2CB07D2KRM96%2CB07TB4XSPZ%2CB01LX97A0E%2CB077MZQ4F9%2CB082QV3Z49%2CB07FPNKQSS%2CB0792DFWJZ%2CB07CB6BHFJ%2CB00LA7UFKW%2CB0054LHI5A%2CB078SFRJ28&amp;srpt=LIP_BALM" target="_blank">Click Here</a><br />Hoodie Options for Kids - Option 1: <a href="https://www.frenchtoast.com/co-ed-heavy-cotton-hoodie/p/4110?size-range=youth&amp;color=purp&amp;size=S&amp;gclid=Cj0KCQjw8eOLBhC1ARIsAOzx5cHVhTa8-yhuDcSQjpwlTzQ3bgtma5v3o0b0NxI2MFFeCBR3fNRdy1saAo-NEALw_wcB" target="_blank">Click Here</a>  |  Option 2: <a href="https://www.amazon.com/Boys-Fashion-Hoodies-Sweatshirts/b?ie=UTF8&amp;node=5604815011" target="_blank">Click Here</a>  |  Option 3: <a href="https://www.amazon.com/s?k=girls+Fashion+Hoodies+%26+Sweatshirts&amp;rh=n%3A5604815011&amp;crid=N0QA5N5QOJTK&amp;sprefix=girls+fashion+hoodies+%26+sweatshirts%2Caps%2C127&amp;ref=nb_sb_noss" target="_blank">Click Here</a><br />30 Pack Composition Notebooks - <a href="https://www.amazon.com/Composition-Notebook-Colors-Journal-Notebooks/dp/B086QFYF8F/ref=sr_1_12?crid=3H2B1KCFXICNH&amp;dchild=1&amp;keywords=composition+notebooks+bulk&amp;qid=1635349540&amp;qsid=133-5546166-7574133&amp;sprefix=composition+notebooks+bulk%2Caps%2C107&amp;sr=8-12&amp;sres=B0028N6PSS%2CB007XZKFSM%2CB08GF98SMD%2CB009NKWY34%2CB00275EBGU%2CB09BBG8JYB%2CB007XZKFTG%2CB086QFYF8F%2CB083NBC6F6%2CB095BVB4Y4%2CB08485GYKM%2CB07D2M8WTN%2CB0080R9C0O%2CB07D2Q4CS4%2CB0947Q6V3J%2CB08485RZB1%2CB09489XCBC%2CB0947QBNX1%2CB08VFCHYLD%2CB08VFFCX6Q&amp;srpt=BLANK_BOOK" target="_blank">Click Here<br /></a>100 Sunscreen packets - <a href="https://www.amazon.com/Sunscreen-Lotion-Packets-SPF30-PABA-free/dp/B00EDU8JG0/ref=sr_1_16?crid=AIDCTU2E7GRI&amp;dchild=1&amp;keywords=sunscreen+bulk&amp;qid=1635349588&amp;qsid=133-5546166-7574133&amp;sprefix=sunscreen+bulk%2Caps%2C130&amp;sr=8-16&amp;sres=B002ZNJYRA%2CB00467BPC0%2CB074P8BS9B%2CB01MQXX9US%2CB004CDV7EY%2CB077D7L95C%2CB00K58Q39Y%2CB07KL5K96X%2CB074W8L151%2CB084R18M8L%2CB00EDU8JG0%2CB07WDQ4Y6Q%2CB078BC1NJ6%2CB0795SY3Q9%2CB086R2JQZH%2CB078BF2BGP%2CB087H5FFGK%2CB01G62TJNY%2CB08CFVM1TT%2CB08FW63P3B&amp;srpt=SUNSCREEN" target="_blank">Click Here</a></p></div> </div></li><li class="form-line" id="id_16"><div class="form-label-left" id="label_16"><label for="input_16"> Total </label></div><div id="cid_16" class="form-input"> <div id="total_amount">$0.00 </div> </div></li><li class="form-line" id="id_11"><div class="form-label-left" id="label_11"><label for="input_11"> Payment </label><label class="label-message" for="input_11"> </label></div><div id="cid_11" 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"></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="q11_payment11[cc_type]" id="input_11_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="q11_payment11[cc_number]" id="input_11_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_11_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="q11_payment11[cc_ccv]" id="input_11_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_11_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="q11_payment11[cc_nameOnCard]" id="input_11_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_11_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[visible]" name="q11_payment11[cc_exp_month]" id="input_11_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_11_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="q11_payment11[cc_exp_year]" id="input_11_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_11_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 form-address-line" type="text" name="q11_payment11[addr_line1]" id="input_11_addr_line1" autocomplete="billing address-line1" />  <label class="form-sub-label" for="input_11_addr_line1" id="sublabel_11_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 form-address-city" type="text" name="q11_payment11[city]" id="input_11_city" autocomplete="billing address-level2" />  <label class="form-sub-label" for="input_11_city" id="sublabel_11_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q11_payment11[state]" id="input_11_state" autocomplete="billing address-level1" />  <label class="form-sub-label" for="input_11_state" id="sublabel_11_state">State / Province</label></span></td></tr><tr class="billing_address "><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-postal" type="text" name="q11_payment11[postal]" id="input_11_postal" size="10" autocomplete="billing postal-code" />  <label class="form-sub-label" for="input_11_postal" id="sublabel_11_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q11_payment11[country]" id="input_11_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_11_country" id="sublabel_11_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_2"><div 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