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	High Holiday Reservations - The Chabad House Palm Beach
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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_7_country" id="sublabel_7_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_6"><div class="form-label-left" 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"> <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="q6_phoneNumber[full]" id="input_6_full" autocomplete="tel" />  <label class="form-sub-label" for="input_6_full"><span> </span></label></span></div> </div></li><li class="form-line" id="id_4"><div class="form-label-left" id="label_4"><label for="input_4"> Email<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 form-label-hidden" id="label_5"></div><div id="cid_5" class="form-input"> <div class="form-single-column form-checkbox-item"><input name="optin" value="true" type="checkbox" checked="checked" class="form-checkbox" id="input_5" /><label id="label_input_5" for="input_5">I would like to receive news and updates by email</label></div> </div></li><li class="form-line" id="id_105"><div class="form-label-left" id="label_105"><label for="input_105"> I am a<span class="form-required">*</span> </label><label class="label-message" for="input_105"> </label></div><div id="cid_105" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_105_0" name="q105_input105" value="Member" /><label id="label_input_105_0" for="input_105_0"><span>Member</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_105_1" name="q105_input105" value="Non-Member" /><label id="label_input_105_1" for="input_105_1"><span>Non-Member</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_105_2" name="q105_input105" value="Alef Preschool Family" /><label id="label_input_105_2" for="input_105_2"><span>Alef Preschool Family</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_159"><div id="cid_159" class="form-input-wide"> <div id="text_159" class="form-html"><p><strong>Consider becoming a member of our Chabad family today! </strong><a href="https://www.palmbeachjewish.com/templates/articlecco_cdo/aid/4505426/jewish/Membership.htm" target="_blank">Click here to learn more</a></p>
</div> </div></li><li class="form-line" id="id_170"><div id="cid_170" class="form-input-wide"> <div id="text_170" class="form-html"><p><strong>Chabad Young Professionals, ages 18 to 36:</strong> Rosh Hashanah meals are at special CYP rates on the CYP page. <a href="https://www.palmbeachjewish.com/templates/articlecco_cdo/aid/6985202/jewish/CYP.htm" target="_blank">Click here to reserve them.</a></p>
</div> </div></li><li class="form-line" id="id_152"><div class="form-label-left" id="label_152"><label for="input_152"> I'd like to reserve for<span class="form-required">*</span> </label><label class="label-message" for="input_152"> </label></div><div id="cid_152" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_152_0" name="q152_input152[]" value="Rosh Hashanah Services" /><label id="label_input_152_0" for="input_152_0"><span>Rosh Hashanah Services</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_152_1" name="q152_input152[]" value="Rosh Hashanah Meals" /><label id="label_input_152_1" for="input_152_1"><span>Rosh Hashanah Meals</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_152_2" name="q152_input152[]" value="Yom Kippur Pre-Fast Meal" /><label id="label_input_152_2" for="input_152_2"><span>Yom Kippur Pre-Fast Meal</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_152_3" name="q152_input152[]" value="Yom Kippur Services" /><label id="label_input_152_3" for="input_152_3"><span>Yom Kippur Services</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_152_4" name="q152_input152[]" value="Yom Kippur Break Fast" /><label id="label_input_152_4" for="input_152_4"><span>Yom Kippur Break Fast</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_9" class="form-input-wide"> <div class="form-header-group"><h2 id="header_9" class="form-header">Rosh Hashanah Seat Reservations</h2></div> </li><li class="form-line" id="id_108"><div class="form-label-left" id="label_108"><label for="input_108"> Services Attending<span class="form-required">*</span> </label><label class="label-message" for="input_108"> </label></div><div id="cid_108" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_0" name="q108_input108[]" value="Evening Service: Friday, Sept. 11, 7:15 PM" /><label id="label_input_108_0" for="input_108_0"><span>Evening Service: Friday, Sept. 11, 7:15 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_1" name="q108_input108[]" value="Children's Program: Friday, Sept. 11, 7:15 – 8:15 PM" /><label id="label_input_108_1" for="input_108_1"><span>Children's Program: Friday, Sept. 11, 7:15 – 8:15 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_2" name="q108_input108[]" value="Morning Services: Shabbat, Sept. 12, 9:30 AM" /><label id="label_input_108_2" for="input_108_2"><span>Morning Services: Shabbat, Sept. 12, 9:30 AM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_3" name="q108_input108[]" value="Sermon: Shabbat, Sept. 12, 12:00 PM" /><label id="label_input_108_3" for="input_108_3"><span>Sermon: Shabbat, Sept. 12, 12:00 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_4" name="q108_input108[]" value="Children's Program: Shabbat, Sept. 12, 11:30 AM – 1:30 PM" /><label id="label_input_108_4" for="input_108_4"><span>Children's Program: Shabbat, Sept. 12, 11:30 AM – 1:30 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_5" name="q108_input108[]" value="Evening Service: Saturday, Sept. 12, 7:45 PM" /><label id="label_input_108_5" for="input_108_5"><span>Evening Service: Saturday, Sept. 12, 7:45 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_6" name="q108_input108[]" value="Children's Program: Saturday, Sept. 12, 7:45 – 8:45 PM" /><label id="label_input_108_6" for="input_108_6"><span>Children's Program: Saturday, Sept. 12, 7:45 – 8:45 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_7" name="q108_input108[]" value="Morning Services: Sunday, Sept. 13, 9:30 AM" /><label id="label_input_108_7" for="input_108_7"><span>Morning Services: Sunday, Sept. 13, 9:30 AM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_8" name="q108_input108[]" value="Sermon and Shofar: Sunday, Sept. 13, 12:00 PM" /><label id="label_input_108_8" for="input_108_8"><span>Sermon and Shofar: Sunday, Sept. 13, 12:00 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_9" name="q108_input108[]" value="Children's Program &amp; Shofar: Sunday, Sept. 13, 11:30 AM – 1:30 PM" /><label id="label_input_108_9" for="input_108_9"><span>Children's Program &amp; Shofar: Sunday, Sept. 13, 11:30 AM – 1:30 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_108_10" name="q108_input108[]" value="Shofar and Tashlich at Worth Avenue Clock Tower: Sunday, Sept. 13, 5:00 PM" /><label id="label_input_108_10" for="input_108_10"><span>Shofar and Tashlich at Worth Avenue Clock Tower: Sunday, Sept. 13, 5:00 PM</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"> Number of Adults<span class="form-required">*</span> </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_18" name="q18_number18" style="width:100px" size="10" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> Number of Children </label><label class="label-message" for="input_10"> Ages 2-12</label></div><div id="cid_10" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_10" name="q10_number" style="width:100px" size="10" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li id="cid_132" class="form-input-wide"> <div class="form-header-group"><h2 id="header_132" class="form-header">Rosh Hashanah Meal Reservations</h2></div> </li><li class="form-line" id="id_100"><div id="cid_100" class="form-input-wide"> <div id="text_100" class="form-html"><p>Members: $100 adult • $50 child (ages 2–17)<br />
Non-members: $125 adult • $65 child (<a href="https://www.palmbeachjewish.com/4505426">CLICK HERE</a> to become a member)<br />
Alef Preschool families: $50 adult • $25 child</p>
</div> </div></li><li class="form-line" id="id_104"><div class="form-label-left" id="label_104"><label for="input_104"> I'd like to reserve for <span class="form-required">*</span> </label><label class="label-message" for="input_104"> </label></div><div id="cid_104" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_104_0" name="q104_input104[]" value="Rosh Hashanah Dinner, Friday, Sept. 11" /><label id="label_input_104_0" for="input_104_0"><span>Rosh Hashanah Dinner, Friday, Sept. 11</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_104_1" name="q104_input104[]" value="Rosh Hashanah Day 1 Lunch, Shabbat, Sept. 12" /><label id="label_input_104_1" for="input_104_1"><span>Rosh Hashanah Day 1 Lunch, Shabbat, Sept. 12</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_104_2" name="q104_input104[]" value="Rosh Hashanah Eve 2 Dinner, Saturday, Sept. 12" /><label id="label_input_104_2" for="input_104_2"><span>Rosh Hashanah Eve 2 Dinner, Saturday, Sept. 12</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_104_3" name="q104_input104[]" value="Rosh Hashanah Day 2 Lunch, Sunday, Sept. 13" /><label id="label_input_104_3" for="input_104_3"><span>Rosh Hashanah Day 2 Lunch, Sunday, Sept. 13</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_75"><div class="form-label-left" id="label_75"><label for="input_75"> Number of Adult Members attending Rosh Hashanah Eve 1 Dinner<span class="form-required">*</span> </label><label class="label-message" for="input_75"> $100 per adult</label></div><div id="cid_75" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_75" name="q75_number75" 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_107"><div class="form-label-left" id="label_107"><label for="input_107"> Number of Adults attending Rosh Hashanah Eve 1 Dinner<span class="form-required">*</span> </label><label class="label-message" for="input_107"> $125 per adult</label></div><div id="cid_107" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_107" name="q107_number107" 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_106"><div class="form-label-left" id="label_106"><label for="input_106"> Number of Children (Member price) attending Rosh Hashanah Eve 1 Dinner </label><label class="label-message" for="input_106"> $50 per child</label></div><div id="cid_106" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_106" name="q106_number106" 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_154"><div class="form-label-left" id="label_154"><label for="input_154"> Number of Children attending Rosh Hashanah Eve 1 Dinner </label><label class="label-message" for="input_154"> $65 per child</label></div><div id="cid_154" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_154" name="q154_number154" 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_161"><div class="form-label-left" id="label_161"><label for="input_161"> Number of Adults (Alef Preschool) attending Rosh Hashanah Eve 1 Dinner<span class="form-required">*</span> </label><label class="label-message" for="input_161"> $50 per adult</label></div><div id="cid_161" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_161" name="q161_numberOf161" 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_160"><div class="form-label-left" id="label_160"><label for="input_160"> Number of Children (Alef Preschool) attending Rosh Hashanah Eve 1 Dinner </label><label class="label-message" for="input_160"> $25 per child</label></div><div id="cid_160" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_160" name="q160_numberOf" 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_110"><div class="form-label-left" id="label_110"><label for="input_110"> Number of Adult Members attending Rosh Hashanah Day 1 Lunch<span class="form-required">*</span> </label><label class="label-message" for="input_110"> $100 per adult</label></div><div id="cid_110" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_110" name="q110_number110" 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_111"><div class="form-label-left" id="label_111"><label for="input_111"> Number of Adults attending Rosh Hashanah Day 1 Lunch<span class="form-required">*</span> </label><label class="label-message" for="input_111"> $125 per adult</label></div><div id="cid_111" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_111" name="q111_number111" 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_155"><div class="form-label-left" id="label_155"><label for="input_155"> Number of Children (Member price) attending Rosh Hashanah Day 1 Lunch </label><label class="label-message" for="input_155"> $50 per child</label></div><div id="cid_155" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_155" name="q155_number155" 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_112"><div class="form-label-left" id="label_112"><label for="input_112"> Number of Children attending Rosh Hashanah Day 1 Lunch </label><label class="label-message" for="input_112"> $65 per child</label></div><div id="cid_112" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_112" name="q112_number112" 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_163"><div class="form-label-left" id="label_163"><label for="input_163"> Number of Adults (Alef Preschool) attending Rosh Hashanah Day 1 Lunch<span class="form-required">*</span> </label><label class="label-message" for="input_163"> $50 per adult</label></div><div id="cid_163" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_163" name="q163_numberOf163" 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_162"><div class="form-label-left" id="label_162"><label for="input_162"> Number of Children (Alef Preschool) attending Rosh Hashanah Day 1 Lunch </label><label class="label-message" for="input_162"> $25 per child</label></div><div id="cid_162" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_162" name="q162_numberOf162" 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_115"><div class="form-label-left" id="label_115"><label for="input_115"> Number of Adult Members attending Rosh Hashanah Eve 2 Dinner<span class="form-required">*</span> </label><label class="label-message" for="input_115"> $100 per adult</label></div><div id="cid_115" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_115" name="q115_number115" 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_116"><div class="form-label-left" id="label_116"><label for="input_116"> Number of Adults attending Rosh Hashanah Eve 2 Dinner<span class="form-required">*</span> </label><label class="label-message" for="input_116"> $125 per adult</label></div><div id="cid_116" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_116" name="q116_number116" 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_117"><div class="form-label-left" id="label_117"><label for="input_117"> Number of Children (Member Price) attending Rosh Hashanah Eve 2 Dinner </label><label class="label-message" for="input_117"> $50 per child</label></div><div id="cid_117" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_117" name="q117_number117" 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_156"><div class="form-label-left" id="label_156"><label for="input_156"> Number of Children attending Rosh Hashanah Eve 2 Dinner </label><label class="label-message" for="input_156"> $65 per child</label></div><div id="cid_156" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_156" name="q156_number156" 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_165"><div class="form-label-left" id="label_165"><label for="input_165"> Number of Adults (Alef Preschool) attending Rosh Hashanah Eve 2 Dinner<span class="form-required">*</span> </label><label class="label-message" for="input_165"> $50 per adult</label></div><div id="cid_165" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_165" name="q165_numberOf165" 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_164"><div class="form-label-left" id="label_164"><label for="input_164"> Number of Children (Alef Preschool) attending Rosh Hashanah Eve 2 Dinner </label><label class="label-message" for="input_164"> $25 per child</label></div><div id="cid_164" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_164" name="q164_numberOf164" 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_119"><div class="form-label-left" id="label_119"><label for="input_119"> Number of Adult Members attending Rosh Hashanah Day 2 Lunch<span class="form-required">*</span> </label><label class="label-message" for="input_119"> $100 per adult</label></div><div id="cid_119" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_119" name="q119_number119" 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_120"><div class="form-label-left" id="label_120"><label for="input_120"> Number of Adults attending Rosh Hashanah Day 2 Lunch<span class="form-required">*</span> </label><label class="label-message" for="input_120"> $125 per adult</label></div><div id="cid_120" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_120" name="q120_number120" 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_157"><div class="form-label-left" id="label_157"><label for="input_157"> Number of Children (Member Price) attending Rosh Hashanah Day 2 Lunch </label><label class="label-message" for="input_157"> $50 per child</label></div><div id="cid_157" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_157" name="q157_number157" 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_121"><div class="form-label-left" id="label_121"><label for="input_121"> Number of Children attending Rosh Hashanah Day 2 Lunch </label><label class="label-message" for="input_121"> $65 per child</label></div><div id="cid_121" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_121" name="q121_number121" 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_167"><div class="form-label-left" id="label_167"><label for="input_167"> Number of Adults (Alef Preschool) attending Rosh Hashanah Day 2 Lunch<span class="form-required">*</span> </label><label class="label-message" for="input_167"> $50 per adult</label></div><div id="cid_167" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_167" name="q167_numberOf167" 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_166"><div class="form-label-left" id="label_166"><label for="input_166"> Number of Children (Alef Preschool) attending Rosh Hashanah Day 2 Lunch </label><label class="label-message" for="input_166"> $25 per child</label></div><div id="cid_166" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_166" name="q166_numberOf166" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li id="cid_87" class="form-input-wide"> <div class="form-header-group"><h2 id="header_87" class="form-header">Yom Kippur Pre-Fast Meal Reservations</h2></div> </li><li class="form-line" id="id_145"><div id="cid_145" class="form-input-wide"> <div id="text_145" class="form-html"><p>Members: $100 adult • $50 child<br />
Non-members: $125 adult • $65 child (<a href="https://www.palmbeachjewish.com/4505426" target="_blank">CLICK HERE</a> to become a member)<br />
Alef Preschool families: $50 adult • $25 child</p>

<p>Break-Fast is complimentary (RSVP below)</p>
</div> </div></li><li class="form-line" id="id_133"><div class="form-label-left" id="label_133"><label for="input_133"> Number of Adult Members attending Pre-Fast Meal<span class="form-required">*</span> </label><label class="label-message" for="input_133"> $100 per adult</label></div><div id="cid_133" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_133" name="q133_number133" 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_151"><div class="form-label-left" id="label_151"><label for="input_151"> Number of Adults attending Pre-Fast Meal<span class="form-required">*</span> </label><label class="label-message" for="input_151"> $125 per adult</label></div><div id="cid_151" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_151" name="q151_number151" 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_135"><div class="form-label-left" id="label_135"><label for="input_135"> Number of Children (Member Price) attending Pre-Fast Meal </label><label class="label-message" for="input_135"> $50 per child</label></div><div id="cid_135" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_135" name="q135_number135" 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_158"><div class="form-label-left" id="label_158"><label for="input_158"> Number of Children attending Pre-Fast Meal </label><label class="label-message" for="input_158"> $65 per child</label></div><div id="cid_158" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_158" name="q158_number158" 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_169"><div class="form-label-left" id="label_169"><label for="input_169"> Number of Adults (Alef Preschool) attending Pre-Fast Meal<span class="form-required">*</span> </label><label class="label-message" for="input_169"> $50 per adult</label></div><div id="cid_169" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_169" name="q169_numberOf169" 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_168"><div class="form-label-left" id="label_168"><label for="input_168"> Number of Children (Alef Preschool) attending Pre-Fast Meal </label><label class="label-message" for="input_168"> $25 per child</label></div><div id="cid_168" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_168" name="q168_numberOf168" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li id="cid_149" class="form-input-wide"> <div class="form-header-group"><h2 id="header_149" class="form-header">Yom Kippur Seat Reservations</h2></div> </li><li class="form-line" id="id_109"><div class="form-label-left" id="label_109"><label for="input_109"> Services Attending </label><label class="label-message" for="input_109"> </label></div><div id="cid_109" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_109_0" name="q109_input109[]" value="Kol Nidrei: Sunday, Sept. 20, 7:00 PM" /><label id="label_input_109_0" for="input_109_0"><span>Kol Nidrei: Sunday, Sept. 20, 7:00 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_109_1" name="q109_input109[]" value="Evening Children's Program: Sunday, Sept. 20, 7:00 – 8:00 PM" /><label id="label_input_109_1" for="input_109_1"><span>Evening Children's Program: Sunday, Sept. 20, 7:00 – 8:00 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_109_2" name="q109_input109[]" value="Morning Service: Monday, Sept. 21, 9:30 AM" /><label id="label_input_109_2" for="input_109_2"><span>Morning Service: Monday, Sept. 21, 9:30 AM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_109_3" name="q109_input109[]" value="Children's Program: Monday, Sept. 21, 11:30 AM – 1:00 PM" /><label id="label_input_109_3" for="input_109_3"><span>Children's Program: Monday, Sept. 21, 11:30 AM – 1:00 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_109_4" name="q109_input109[]" value="Sermon and Yizkor: Monday, Sept. 21, 12:30 PM" /><label id="label_input_109_4" for="input_109_4"><span>Sermon and Yizkor: Monday, Sept. 21, 12:30 PM</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_109_5" name="q109_input109[]" value="Neilah/Concluding Service followed by complimentary break-the-fast: Monday, Sept. 21, 5:45 PM" /><label id="label_input_109_5" for="input_109_5"><span>Neilah/Concluding Service followed by complimentary break-the-fast: Monday, Sept. 21, 5:45 PM</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_146"><div class="form-label-left" id="label_146"><label for="input_146"> Number of Adults<span class="form-required">*</span> </label><label class="label-message" for="input_146"> </label></div><div id="cid_146" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_146" name="q146_number146" 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_139"><div class="form-label-left" id="label_139"><label for="input_139"> Number of Children </label><label class="label-message" for="input_139"> Ages 2–12</label></div><div id="cid_139" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_139" name="q139_number139" 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_138"><div class="form-label-left" id="label_138"><label for="input_138"> Number attending Break-Fast<span class="form-required">*</span> </label><label class="label-message" for="input_138"> </label></div><div id="cid_138" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_138" name="q138_number138" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li id="cid_148" class="form-input-wide"> <div class="form-header-group"><h2 id="header_148" class="form-header">Reservation Information</h2></div> </li><li class="form-line" id="id_62"><div class="form-label-left" id="label_62"><label for="input_62"> Reservation Names and Comments<span class="form-required">*</span> </label><label class="label-message" for="input_62"> </label></div><div id="cid_62" class="form-input"> <textarea id="input_62" class="form-textarea validate[required]" name="q62_input62" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_153"><div class="form-label-left" id="label_153"><label for="input_153"> Names and Ages of Children<span class="form-required">*</span> </label><label class="label-message" for="input_153"> attending children's program</label></div><div id="cid_153" class="form-input"> <textarea id="input_153" class="form-textarea validate[required]" name="q153_input153" cols="40" rows="6"></textarea> </div></li><li id="cid_58" class="form-input-wide"> <div class="form-header-group"><h2 id="header_58" class="form-header">Donate &amp; Sponsorships</h2></div> </li><li class="form-line" id="id_56"><div class="form-label-left" id="label_56"><label for="input_56"> Sponsorship Amounts </label><label class="label-message" for="input_56"> </label></div><div id="cid_56" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_56_0" name="q56_input56" value="High Holiday Sponsor - $18,000" /><label id="label_input_56_0" for="input_56_0"><span>High Holiday Sponsor - $18,000</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_56_1" name="q56_input56" value="Corporate Sponsor - $10,000" /><label id="label_input_56_1" for="input_56_1"><span>Corporate Sponsor - $10,000</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_56_2" name="q56_input56" value="Benefactor - $3,600" /><label id="label_input_56_2" for="input_56_2"><span>Benefactor - $3,600</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_56_3" name="q56_input56" value="Partner - $1,800" /><label id="label_input_56_3" for="input_56_3"><span>Partner - $1,800</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_56_4" name="q56_input56" value="Friend - $1,000" /><label id="label_input_56_4" for="input_56_4"><span>Friend - $1,000</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_56_5" name="q56_input56" value="Sponsor - $500" /><label id="label_input_56_5" for="input_56_5"><span>Sponsor - $500</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_56_6" name="q56_input56" value="Double Chai - $360" /><label id="label_input_56_6" for="input_56_6"><span>Double Chai - $360</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio validate[other]" name="q56_input56" id="other_56" value="" /><span><input type="number" min="1" onkeypress="validateNumber(event)" class="form-radio-other-input form-textbox undefined" name="q56_input56[other]" data-otherhint="Other" size="15" id="input_56" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_71"><div class="form-label-left" id="label_71"><label for="input_71"> Membership </label><label class="label-message" for="input_71"> </label></div><div id="cid_71" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_71_0" name="q71_input71[]" value="Please consider my contribution as my membership" /><label id="label_input_71_0" for="input_71_0"><span>Please consider my contribution as my membership</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_59" class="form-input-wide"> <div class="form-header-group"><h2 id="header_59" class="form-header">Payment</h2></div> </li><li class="form-line" id="id_60"><div class="form-label-left" id="label_60"><label for="input_60"> Payment<span class="form-required">*</span> </label><label class="label-message" for="input_60"> </label></div><div id="cid_60" 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"><span class="form-radio-item"><input class="paymentMethod form-radio validate[required, paymentMethod] form-radio" type="radio" id="input_60_creditCard" name="q60_payment[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_60_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[required, paymentMethod] form-radio" type="radio" id="input_60_paypal" name="q60_payment[payment_method]" value="paypal" onclick="BuildSource.paypal(this)" /><label for="input_60_paypal">Paypal</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[required, paymentMethod] form-radio" type="radio" id="input_60_other" name="q60_payment[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_60_other">Check / Cash App</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="q60_payment[cc_type]" id="input_60_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="q60_payment[cc_number]" id="input_60_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_60_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="q60_payment[cc_ccv]" id="input_60_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_60_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="q60_payment[cc_nameOnCard]" id="input_60_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_60_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="q60_payment[cc_exp_month]" id="input_60_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_60_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="q60_payment[cc_exp_year]" id="input_60_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_60_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="paypal hide"><td colspan="2">Paypal has been selected. Payment will take place on the next page.</td></tr><tr class="other hide"><td colspan="2">Cash/check payable to The Chabad House: 361 S. County Rd. Palm Beach, FL 33480.&lt;br /&gt;&lt;br /&gt;Cash App: $HindelLevitin.&lt;br /&gt;&lt;br /&gt;Please click SUBMIT at the bottom of this page and then visit paypal.com or CashApp to send your payment total, this form does not automatically redirect you to pay.</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="q60_payment[addr_line1]" id="input_60_addr_line1" autocomplete="billing address-line1" />  <label class="form-sub-label" for="input_60_addr_line1" id="sublabel_60_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="q60_payment[city]" id="input_60_city" autocomplete="billing address-level2" />  <label class="form-sub-label" for="input_60_city" id="sublabel_60_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q60_payment[state]" id="input_60_state" autocomplete="billing address-level1" />  <label class="form-sub-label" for="input_60_state" id="sublabel_60_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="q60_payment[postal]" id="input_60_postal" size="10" autocomplete="billing postal-code" />  <label class="form-sub-label" for="input_60_postal" id="sublabel_60_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q60_payment[country]" id="input_60_country" autocomplete="billing country-name"><option value="" selected="selected">Please Select</option><option selected="selected" 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 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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 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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 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