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			<h1 class="article-header__title js-article-title js-page-title">Chabad Interest form</h1>
		
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<form class="userform-form" action="" method="post" name="form_6101750" id="6101750" accept-charset="utf-8"><input type="hidden" name="formID" value="6101750" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_3"><div id="cid_3" class="form-input-wide"> <div style="text-align:center;"><img alt="" class="form-image" border="0" src="https://w2.chabad.org/media/images/978/RyYk9784030.jpg" height="150" width="150" /></div> </div></li><li class="form-line" id="id_1"><div id="cid_1" class="form-input-wide"> <div id="text_1" class="form-html"><p style="text-align: center;"><span style="font-size: 28px;"><span style="font-family: Times New Roman;">Thank you for your interest in being a part of the Chabad Jewish Community of Whatcom County!</span></span></p>
</div> </div></li><li class="form-line" id="id_4"><div class="form-label-left" id="label_4"><label for="input_4"> Name<span class="form-required">*</span> </label><label class="label-message" for="input_4"> </label></div><div id="cid_4" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q4_fullName[first]" id="first_4" autocomplete="given-name" />  <label class="form-sub-label" for="first_4" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q4_fullName[last]" id="last_4" autocomplete="family-name" />  <label class="form-sub-label" for="last_4" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_5" name="q5_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q7_phoneNumber[area]" id="input_7_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_7_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q7_phoneNumber[phone]" id="input_7_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" 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autocomplete="address-line2" />  <label class="form-sub-label" for="input_21_addr_line2" id="sublabel_21_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="q21_address[city]" id="input_21_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_21_city" id="sublabel_21_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q21_address[state]" id="input_21_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_21_state" id="sublabel_21_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="q21_address[postal]" id="input_21_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_21_postal" id="sublabel_21_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q21_address[country]" id="input_21_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 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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_21_country" id="sublabel_21_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Are you Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_9_0" name="q9_input9" value="Yes, Born Jewish." /><label id="label_input_9_0" for="input_9_0"><span>Yes, Born Jewish.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_9_1" name="q9_input9" value="Yes, Converted to Judaism." /><label id="label_input_9_1" for="input_9_1"><span>Yes, Converted to Judaism.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_9_2" name="q9_input9" value="No." /><label id="label_input_9_2" for="input_9_2"><span>No.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_16"><div class="form-label-left" id="label_16"><label for="input_16"> Is your mom Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_16_0" name="q16_input16" value="Yes, Born Jewish." /><label id="label_input_16_0" for="input_16_0"><span>Yes, Born Jewish.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_16_1" name="q16_input16" value="Yes, Converted to Judaism." /><label id="label_input_16_1" for="input_16_1"><span>Yes, Converted to Judaism.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_16_2" name="q16_input16" value="No." /><label id="label_input_16_2" for="input_16_2"><span>No.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> Is your dad Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_17_0" name="q17_input17" value="Yes, Born Jewish." /><label id="label_input_17_0" for="input_17_0"><span>Yes, Born Jewish.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_17_1" name="q17_input17" value="Yes, Converted to Judaism." /><label id="label_input_17_1" for="input_17_1"><span>Yes, Converted to Judaism.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_17_2" name="q17_input17" value="No." /><label id="label_input_17_2" for="input_17_2"><span>No.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_26"><div class="form-label-left" id="label_26"><label for="input_26"> Is your maternal grandmother Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_26"> </label></div><div id="cid_26" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_26_0" name="q26_input26" value="Yes, Born Jewish." /><label id="label_input_26_0" for="input_26_0"><span>Yes, Born Jewish.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_26_1" name="q26_input26" value="Yes, Converted to Judaism." /><label id="label_input_26_1" for="input_26_1"><span>Yes, Converted to Judaism.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_26_2" name="q26_input26" value="No." /><label id="label_input_26_2" for="input_26_2"><span>No.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_26_3" name="q26_input26" value="I don't Know" /><label id="label_input_26_3" for="input_26_3"><span>I don't Know</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> Are you married?<span class="form-required">*</span> </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_15_0" name="q15_input15" value="Yes" /><label id="label_input_15_0" for="input_15_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_15_1" name="q15_input15" value="No" /><label id="label_input_15_1" for="input_15_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_29"><div class="form-label-left" id="label_29"><label for="input_29"> Spouse's Name<span class="form-required">*</span> </label><label class="label-message" for="input_29"> </label></div><div id="cid_29" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q29_fullName29[first]" id="first_29" autocomplete="given-name" />  <label class="form-sub-label" for="first_29" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q29_fullName29[last]" id="last_29" autocomplete="family-name" />  <label class="form-sub-label" for="last_29" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_30"><div class="form-label-left" id="label_30"><label for="input_30"> Is your spouse Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_30"> </label></div><div id="cid_30" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_30_0" name="q30_input30" value="Yes, Born Jewish." /><label id="label_input_30_0" for="input_30_0"><span>Yes, Born Jewish.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_30_1" name="q30_input30" value="Yes, Converted to Judaism." /><label id="label_input_30_1" for="input_30_1"><span>Yes, Converted to Judaism.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_30_2" name="q30_input30" value="No." /><label id="label_input_30_2" for="input_30_2"><span>No.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Is your spouse's mom Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_18_0" name="q18_input18" value="Yes, Born Jewish." /><label id="label_input_18_0" for="input_18_0"><span>Yes, Born Jewish.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_18_1" name="q18_input18" value="Yes, Converted to Judaism." /><label id="label_input_18_1" for="input_18_1"><span>Yes, Converted to Judaism.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_18_2" name="q18_input18" value="No." /><label id="label_input_18_2" for="input_18_2"><span>No.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> Is your spouse's dad Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_19_0" name="q19_input19" value="Yes, Born Jewish." /><label id="label_input_19_0" for="input_19_0"><span>Yes, Born Jewish.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_19_1" name="q19_input19" value="Yes, Converted to Judaism." /><label id="label_input_19_1" for="input_19_1"><span>Yes, Converted to Judaism.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_19_2" name="q19_input19" value="No." /><label id="label_input_19_2" for="input_19_2"><span>No.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_27"><div class="form-label-left" id="label_27"><label for="input_27"> Is your spouse's maternal Grandmother Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_27"> </label></div><div id="cid_27" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_27_0" name="q27_input27" value="Yes, Born Jewish." /><label id="label_input_27_0" for="input_27_0"><span>Yes, Born Jewish.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_27_1" name="q27_input27" value="Yes, Converted to Judaism." /><label id="label_input_27_1" for="input_27_1"><span>Yes, Converted to Judaism.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_27_2" name="q27_input27" value="No." /><label id="label_input_27_2" for="input_27_2"><span>No.</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_27_3" name="q27_input27" value="I don't Know" /><label id="label_input_27_3" for="input_27_3"><span>I don't Know</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"> Do you have children living at home?<span class="form-required">*</span> </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_20_0" name="q20_input20" value="Yes" /><label id="label_input_20_0" for="input_20_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_20_1" name="q20_input20" value="No" /><label id="label_input_20_1" for="input_20_1"><span>No</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"> How many?<span class="form-required">*</span> </label><label class="label-message" for="input_22"> </label></div><div id="cid_22" class="form-input"> <select class="form-dropdown validate[required]" style="width:150px" id="input_22" name="q22_input22"><option value=""></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option></select> </div></li><li class="form-line" id="id_24"><div class="form-label-left" id="label_24"><label for="input_24"> Please List their names, Genders, and Ages.<span class="form-required">*</span> </label><label class="label-message" for="input_24"> </label></div><div id="cid_24" class="form-input"> <textarea id="input_24" class="form-textarea validate[required]" name="q24_input24" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> Jewish Event interest </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_0" name="q10_input10[]" value="Community Shabbat Dinners" /><label id="label_input_10_0" for="input_10_0"><span>Community Shabbat Dinners</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_10_1" name="q10_input10[]" value="Holiday Programs" /><label 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