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<td bgcolor="#d3ccc4" valign="top" width="83" style=" font-size: 10px"><img border="0" alt="reservationFORM.jpg" src="https://w2.chabad.org/media/images/464/BgRl4641555.jpg" /></td>
<td width="340">
<p class="SCbox_solid_line" align="center" style="font-size: 12pt"><strong>Passover Seder 2012 <br />
Reservation Form</strong></p>
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<td bgcolor="#ebebeb" height="15" width="101" style="text-align: right; font-size: 12px"><strong>Name:</strong></td>
<td height="15" width="299" style=" font-size: 10px"><input tabindex="1" size="28" required="true" style="width: 217px; height: 22px" name="Name" type="text" /></td>
</tr>
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<td bgcolor="#ebebeb" height="15" width="101" style="text-align: right; font-size: 12px"><strong>Address 1:</strong></td>
<td height="15" width="101"><input tabindex="1" size="18" required="true" style="width: 177px; height: 22px" name="Address" type="text" /></td>
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<td bgcolor="#ebebeb" height="15" width="101" style="text-align: right; font-size: 12px"><strong>Address 2:</strong></td>
<td height="15" width="101"><input tabindex="1" size="18" required="false" style="width: 177px; height: 22px" name="Address2" type="text" /></td>
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<td bgcolor="#ebebeb" height="15" width="101" style="text-align: right; font-size: 12px"><strong>City:</strong></td>
<td height="15" width="101"><input tabindex="1" size="19" required="true" style="width: 158px; height: 22px" name="City" type="text" /></td>
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<td bgcolor="#ebebeb" height="15" width="101" style="text-align: right; font-size: 12px"><strong>Province:</strong></td>
<td height="15" width="101"><input tabindex="1" size="15" required="true" style="width: 126px; height: 22px" name="Province" type="text" /></td>
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<td bgcolor="#ebebeb" height="15" width="101" style="text-align: right; font-size: 12px"><strong>Postal Code:</strong></td>
<td height="15" width="101"><input tabindex="1" size="8" required="true" style="width: 69px; height: 22px" name="Postal_Code" type="text" /></td>
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<td bgcolor="#ebebeb" height="15" width="101" style="text-align: right; font-size: 12px"><strong>Phone:</strong></td>
<td height="15" width="299"><input tabindex="1" size="31" required="true" style="width: 247px; height: 22px" name="Phone" type="text" /></td>
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<td bgcolor="#ebebeb" height="15" width="101" style="text-align: right; font-size: 12px"><strong>E-mail:</strong></td>
<td height="15" width="299"><input tabindex="1" size="30" required="true" style="width: 245px; height: 22px" name="Email" type="text" /></td>
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</table>
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<td bgcolor="#ebebeb" height="15" width="50%" style="text-align: center; font-size: 10px"><span style="font-size: 10px">Adults</span> <span style="color: #ff0000; font-size: 10px">*</span> <span><br />
<input tabindex="1" size="1" required="false" name="Number of Adults" type="text" /> <br />
$60.00</span></td>
<td bgcolor="#ebebeb" height="15" width="50%" style="text-align: center; font-size: 10px"><span style="font-size: 10px">Child (3-12) <span style="color: #ff0000">*</span> <br />
<input tabindex="1" size="1" required="false" name="Number of Childs" type="text" /> <br />
$25.00</span></td>
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</tbody>
</table>
<table dir="ltr" border="0" cellspacing="5" cellpadding="0" width="100%" style="border-collapse: collapse;">
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<td bgcolor="#ebebeb" height="15" width="100%"><input tabindex="1" type="checkbox" name="Sponsor" value="on" />I would like to be an sponsor for an extra $180.00 <br />
<span style="color: #ff0000">* Price increases by $10 per ticket for tickets purchased after April 2nd, noon. <br />
<br />
</span><span style="color: #993300"><strong>ENTRY WITH TICKETS ONLY!</strong></span></td>
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</tbody>
</table>
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<td bgcolor="#ebebeb" height="15" width="50%" style="text-align: right; font-size: 10px"><strong><font size="2">Credit Card Type:</font></strong></td>
<td bgcolor="#ebebeb" height="15" width="50%" style="text-align: left; font-size: 10px"><select tabindex="1" size="1" name="Credit_Card_Type">
<option value="Visa" selected="selected">Visa</option>
<option value="Master Card">Master Card</option>
</select></td>
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<td bgcolor="#ebebeb" height="15" width="50%" style="text-align: right; font-size: 10px"><strong><font size="2">Credit Card Number:</font></strong></td>
<td bgcolor="#ebebeb" height="15" width="50%" style="text-align: left; font-size: 10px"><input tabindex="1" required="false" name="Credit_Card_Number" type="text" /></td>
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<td bgcolor="#ebebeb" height="15" width="50%" style="text-align: right; font-size: 10px"><strong><span style="font-size: 9pt">Exp.(<em>mm/yyyy)</em>:</span></strong></td>
<td bgcolor="#ebebeb" height="15" width="50%" style="text-align: left; font-size: 10px"><select tabindex="1" size="1" name="MonthCreditCard">
<option value="01" selected="selected">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select> <span style="font-size: 9pt">/ <select tabindex="1" name="YearCreditCard">
<option value="2012" selected="selected">2012</option>
<option value="2013">2013</option>
<option value="2014">2014</option>
<option value="2015">2015</option>
<option value="2016">2016</option>
<option value="2017">2017</option>
<option value="2018">2018</option>
</select></span></td>
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</tbody>
</table>
<p class="SCbox_dotted_line"> <font size="2"><input tabindex="1" type="checkbox" name="Cheque" value="Yes" />My cheque payable to Chabad of Midtown is in the mail. <br />
</font></p>
<p align="center" style="font-size: 9pt">Please mail all cheques to Chabad of Midtown <br />
1344 Bathurst St. Toronto, ON M5R 3H7</p>
<p align="center"><strong><font size="2">Thank you so much!...</font></strong></p>
<p align="center"><span style="font-size: 9pt">For any questions, please contact us:</span> <a href="
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