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			<h1 class="article-header__title js-article-title js-page-title">Yizkor Memorial Services</h1>
		
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<form class="userform-form" action="" method="post" name="form_4852266" id="4852266" accept-charset="utf-8">
  <input type="hidden" name="formID" value="4852266" />
  <div class="form-all dir_ltr" dir="ltr">
    <ul class="form-section">
      <li class="form-line" id="id_47">
        <div id="cid_47" class="form-input-wide">
          <div id="text_47" class="form-html">
            <p style="text-align: center;">
              <strong><span style="font-family: Verdana; color: rgb(153, 51, 0);">Yizkor, a special memorial prayer for the departed, is recited in the synagogue four times a year, following the Torah reading on the last day of Passover, on the second day of Shavuot, on Shemini Atzeret and on Yom Kippur.</span>
              </strong>
            </p>
            <p style="text-align: center;">
              <strong><span style="font-family: Verdana; color: rgb(153, 51, 0);">Yizkor, in Hebrew, means "Remember." It is not only the first word of the prayer, it also represents its overall theme. In this prayer, we implore G dto remember the souls of our relatives and friends that have passed on.</span>
              </strong>
            </p>
            <p style="text-align: center;">
              <strong><span style="font-family: Verdana; color: rgb(153, 51, 0);">When we recite Yizkor, we renew and strengthen the connection between us and our loved one, bringing merit to the departed souls, elevating them in their celestial homes.</span>
              </strong>
            </p>
            <p style="text-align: center;">
              <strong><span style="font-family: Verdana; color: rgb(153, 51, 0);">Please fill out the list below to include your loved ones in a communal prayer of E-L Moloei Rachamaim.</span>
              </strong>
            </p>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_4">
        <div class="form-label-left" id="label_4">
          <label for="input_4">
            Full 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" />
            <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" />
            <label class="form-sub-label" for="last_4" id="sublabel_last"> Last Name </label></span>
        </div>
      </li>
      <li class="form-line" id="id_7">
        <div class="form-label-left" id="label_7">
          <label for="input_7">
            E-mail<span class="form-required">*</span>
          </label>
          <label class="label-message" for="input_7">  </label>
        </div>
        <div id="cid_7" class="form-input">
          <input type="email" class=" form-textbox validate[required, Email]" id="input_7" name="q7_email" size="30" value="" />
        </div>
      </li>
      <li class="form-line" id="id_6">
        <div class="form-label-left" id="label_6">
          <label for="input_6">
            Address<span class="form-required">*</span>
          </label>
          <label class="label-message" for="input_6">  </label>
        </div>
        <div id="cid_6" 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="q6_address[addr_line1]" id="input_6_addr_line1" size="46" />
                  <label class="form-sub-label" for="input_6_addr_line1" id="sublabel_6_addr_line1"> Street Address </label></span>
              </td>
            </tr>
            <tr>
              <td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q6_address[addr_line2]" id="input_6_addr_line2" size="46" />
                  <label class="form-sub-label" for="input_6_addr_line2" id="sublabel_6_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="q6_address[city]" id="input_6_city" size="21" />
                  <label class="form-sub-label" for="input_6_city" id="sublabel_6_city"> City </label></span>
              </td>
              <td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q6_address[state]" id="input_6_state" size="22" />
                  <label class="form-sub-label" for="input_6_state" id="sublabel_6_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="q6_address[postal]" id="input_6_postal" size="10" />
                  <label class="form-sub-label" for="input_6_postal" id="sublabel_6_postal"> Postal / Zip Code </label></span>
              </td>
              <td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q6_address[country]" id="input_6_country">
                    <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_6_country" id="sublabel_6_country"> Country </label></span>
              </td>
            </tr>
          </tbody></table>
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      </li>
      <li class="form-line" id="id_5">
        <div class="form-label-left" id="label_5">
          <label for="input_5"> Phone Number </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[Numeric]" type="tel" name="q5_phoneNumber[area]" id="input_5_area" 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[Numeric]" type="tel" name="q5_phoneNumber[phone]" id="input_5_phone" 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_27">
        <div class="form-label-left" id="label_27">
          <label for="input_27">
            1. English Name of Deceased<span class="form-required">*</span>
          </label>
          <label class="label-message" for="input_27">  </label>
        </div>
        <div id="cid_27" class="form-input">
          <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_27" name="q27_input27" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_28">
        <div class="form-label-left" id="label_28">
          <label for="input_28">
            1. Hebrew Name<span class="form-required">*</span>
          </label>
          <label class="label-message" for="input_28"> Example Issac Ben Abraham </label>
        </div>
        <div id="cid_28" class="form-input">
          <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_28" name="q28_input28" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_43">
        <div class="form-label-left" id="label_43">
          <label for="input_43">
            Relation<span class="form-required">*</span>
          </label>
          <label class="label-message" for="input_43">  </label>
        </div>
        <div id="cid_43" class="form-input">
          <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_43" name="q43_input43" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_29">
        <div class="form-label-left" id="label_29">
          <label for="input_29">
            1. Date of Passing<span class="form-required">*</span>
          </label>
          <label class="label-message" for="input_29">  </label>
        </div>
        <div id="cid_29" class="form-input">
          <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_29" name="q29_input29" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_30">
        <div class="form-label-left" id="label_30">
          <label for="input_30">
            1. Time of Passing<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-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_30_0" name="q30_input30" value="Before Sundown" />
              <label id="label_input_30_0" for="input_30_0"><span>Before Sundown</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_1" name="q30_input30" value="After Sundown" />
              <label id="label_input_30_1" for="input_30_1"><span>After Sundown</span>
              </label></span><span class="clearfix"></span>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_31">
        <div class="form-label-left" id="label_31">
          <label for="input_31"> 2. Name of Deceased </label>
          <label class="label-message" for="input_31">  </label>
        </div>
        <div id="cid_31" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_31" name="q31_input31" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_34">
        <div class="form-label-left" id="label_34">
          <label for="input_34"> 2. Hebrew Name </label>
          <label class="label-message" for="input_34">  </label>
        </div>
        <div id="cid_34" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_34" name="q34_input34" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_44">
        <div class="form-label-left" id="label_44">
          <label for="input_44"> Relation </label>
          <label class="label-message" for="input_44">  </label>
        </div>
        <div id="cid_44" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_44" name="q44_input44" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_37">
        <div class="form-label-left" id="label_37">
          <label for="input_37"> 2. Date of Passing </label>
          <label class="label-message" for="input_37">  </label>
        </div>
        <div id="cid_37" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_37" name="q37_input37" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_40">
        <div class="form-label-left" id="label_40">
          <label for="input_40"> 2. Time of Passing </label>
          <label class="label-message" for="input_40">  </label>
        </div>
        <div id="cid_40" class="form-input">
          <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_40_0" name="q40_input40" value="Before Sundown" />
              <label id="label_input_40_0" for="input_40_0"><span>Before Sundown</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_40_1" name="q40_input40" value="After Sundown" />
              <label id="label_input_40_1" for="input_40_1"><span>After Sundown</span>
              </label></span><span class="clearfix"></span>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_32">
        <div class="form-label-left" id="label_32">
          <label for="input_32"> 3. Name of Deceased </label>
          <label class="label-message" for="input_32">  </label>
        </div>
        <div id="cid_32" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_32" name="q32_input32" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_35">
        <div class="form-label-left" id="label_35">
          <label for="input_35"> 3. Hebrew Name </label>
          <label class="label-message" for="input_35">  </label>
        </div>
        <div id="cid_35" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_35" name="q35_input35" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_45">
        <div class="form-label-left" id="label_45">
          <label for="input_45"> Relation </label>
          <label class="label-message" for="input_45">  </label>
        </div>
        <div id="cid_45" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_45" name="q45_input45" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_38">
        <div class="form-label-left" id="label_38">
          <label for="input_38"> 3. Date of Passing </label>
          <label class="label-message" for="input_38">  </label>
        </div>
        <div id="cid_38" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_38" name="q38_input38" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_41">
        <div class="form-label-left" id="label_41">
          <label for="input_41"> 3. Time of Passing </label>
          <label class="label-message" for="input_41">  </label>
        </div>
        <div id="cid_41" class="form-input">
          <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_41_0" name="q41_input41" value="Before Sundown" />
              <label id="label_input_41_0" for="input_41_0"><span>Before Sundown</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_41_1" name="q41_input41" value="After Sundown" />
              <label id="label_input_41_1" for="input_41_1"><span>After Sundown</span>
              </label></span><span class="clearfix"></span>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_33">
        <div class="form-label-left" id="label_33">
          <label for="input_33"> 4. Name of Deceased </label>
          <label class="label-message" for="input_33">  </label>
        </div>
        <div id="cid_33" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_33" name="q33_input33" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_36">
        <div class="form-label-left" id="label_36">
          <label for="input_36"> 4. Hebrew Name </label>
          <label class="label-message" for="input_36">  </label>
        </div>
        <div id="cid_36" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_36" name="q36_input36" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_46">
        <div class="form-label-left" id="label_46">
          <label for="input_46"> Relation </label>
          <label class="label-message" for="input_46">  </label>
        </div>
        <div id="cid_46" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_46" name="q46_input46" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_39">
        <div class="form-label-left" id="label_39">
          <label for="input_39"> 4. Date of Passing </label>
          <label class="label-message" for="input_39">  </label>
        </div>
        <div id="cid_39" class="form-input">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_39" name="q39_input39" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_42">
        <div class="form-label-left" id="label_42">
          <label for="input_42"> 4. Time of Passing </label>
          <label class="label-message" for="input_42">  </label>
        </div>
        <div id="cid_42" class="form-input">
          <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_42_0" name="q42_input42" value="Before Sundown" />
              <label id="label_input_42_0" for="input_42_0"><span>Before Sundown</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_42_1" name="q42_input42" value="After Sundown" />
              <label id="label_input_42_1" for="input_42_1"><span>After Sundown</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"> I would like to make a donation toward the Yizkor Service (optional): </label>
          <label class="label-message" for="input_26">  </label>
        </div>
        <div id="cid_26" class="form-input">
          <div class="form-single-column"><span class="form-radio-item simple-mode"><label id="label_input_26" for="input_26"><span>$</span>
              </label>
              <input type="text" class="form-textbox" id="input_26" name="q26_input26" value="" onkeypress="validateNumber(event)" /></span><span class="clearfix"></span>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_21">
        <div class="form-label-left" id="label_21">
          <label for="input_21"> Total </label>
        </div>
        <div id="cid_21" class="form-input">
          <div id="total_amount">
            $0.00
          </div>
        </div>
      </li>
      <li class="form-line" id="id_22">
        <div class="form-label-left" id="label_22">
          <label for="input_22"> Payment </label>
          <label class="label-message" for="input_22">  </label>
        </div>
        <div id="cid_22" 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"><select class="form-textbox validate[visible]" name="q22_payment[cc_type]" id="input_22_cc_type">
                          <option value="Visa"> Visa </option>
                          <option value="Mastercard"> MasterCard </option>
                          <option value="Amex"> American Express </option>
                          <option value="Discover"> Discover </option>
                        </select>
                        <label class="form-sub-label" for="input_22_cc_type" id="sublabel_cc_type"> Credit Card Type </label></span>
                    </td>
                  </tr>
                  <tr>
                    <td><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q22_payment[cc_number]" id="input_22_cc_number" size="20" autocomplete="off" />
                        <label class="form-sub-label" for="input_22_cc_number" id="sublabel_cc_number"> Credit Card Number </label></span>
                    </td>
                    <td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q22_payment[cc_ccv]" id="input_22_cc_ccv" size="6" autocomplete="off" />
                        <label class="form-sub-label" for="input_22_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="q22_payment[cc_nameOnCard]" id="input_22_cc_nameOnCard" size="33" autocomplete="off" />
                        <label class="form-sub-label" for="input_22_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="q22_payment[cc_exp_month]" id="input_22_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_22_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="q22_payment[cc_exp_year]" id="input_22_cc_exp_year">
                          <option>  </option>
                          <option value="2020"> 2020 </option>
                          <option value="2021"> 2021 </option>
                          <option value="2022"> 2022 </option>
                          <option value="2023"> 2023 </option>
                          <option value="2024"> 2024 </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>
                        </select>
                        <label class="form-sub-label" for="input_22_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="q22_payment[addr_line1]" id="input_22_addr_line1" />
                  <label class="form-sub-label" for="input_22_addr_line1" id="sublabel_22_addr_line1"> Street Address </label></span>
              </td>
            </tr>
            <tr class="billing_address ">
              <td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q22_payment[addr_line2]" id="input_22_addr_line2" size="46" />
                  <label class="form-sub-label" for="input_22_addr_line2" id="sublabel_22_addr_line2"> Street Address Line 2 </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="q22_payment[city]" id="input_22_city" />
                  <label class="form-sub-label" for="input_22_city" id="sublabel_22_city"> City </label></span>
              </td>
              <td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q22_payment[state]" id="input_22_state" />
                  <label class="form-sub-label" for="input_22_state" id="sublabel_22_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="q22_payment[postal]" id="input_22_postal" size="10" />
                  <label class="form-sub-label" for="input_22_postal" id="sublabel_22_postal"> Postal / Zip Code </label></span>
              </td>
              <td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q22_payment[country]" id="input_22_country">
                    <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>
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