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	JMed Registration - Chabad Chai Center
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		<div width="100%" class="cco_templateless_template" style="z-index:100 !important;display:block !important;left:0px !important;top:0px !important;height:30px!important;width:100% !important;line-height:30px !important; position:relative !important; margin-bottom:0 !important; padding:0;text-indent: 25px;" align="Left"><a href="//www.GetChai.com" style="display:block!important;font-size:14px !important;">&laquo; Back to&nbsp;Chabad Chai Center</a></div>
	
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                      <p style="text-align: center;"> <a href="/Article.asp?AID=2171750"><img width="160" vspace="15" height="100" border="0" alt="" real_height="156" real_width="250" src="https://origin.ih.constantcontact.com/fs121/1101573181686/img/726.png"></a></p>
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                    <td width="25%" style="text-align: center;"> </td>
                    <td width="41%" style="text-align: right;">
                      <p style="text-align: center;"><img width="148" vspace="15" height="100" border="0" alt="Finance-Logo.jpg" real_height="289" real_width="428" src="https://w2.chabad.org/media/images/778/ljbQ7785229.jpg"></p>
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                              <p>
                                <font color="#9BD64A"><span style="font-size: 20px; line-height: 24px;"><a href="https://www.facebook.com/events/424142287686773"><img border="0" align="left" alt="" real_height="50" real_width="50" src="https://origin.ih.constantcontact.com/fs121/1101573181686/img/725.png"></a> UPCOMING EVENT - Sunday, November 24  
<br></span></font>
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<p style="text-align: justify;"><span style="font-family: Arial;"><strong><span style="color: rgb(255, 255, 255); font-size: 18px; font-family: arial;">Sushi and Cocktails - Chai Medical</span></strong></span></p>
<p style="text-align: justify;"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">5:30pm: Sushi and Cocktails</span></p>
<p style="text-align: justify;"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">6:00pm: Lecture</span> <span style="font-family: Arial; font-size: 14px; color: rgb(255, 255, 255);">- Presenter: Michael A. Grodin, M.D., FAAP
<br></span> <em><span style="font-family: Arial; font-size: 14px; color: rgb(255, 255, 255);">Professor of Philosophy, Medicine, Public Health and Management
<br>
 at Boston University School of Medicine
<br></span></em></p>
<p style="text-align: justify;"><span style="font-family: Arial; font-size: 14px; color: rgb(255, 255, 255);">7:00pm: Networking</span></p>
<p style="text-align: justify;"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">In addition to plenty of sushi and drinks you will get to network with 50 plus young adults in the medical field.</span></p>
<p style="text-align: justify;"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">$25 Couvert - $180 Sponsor (Includes 3 seats)</span></p>
<p style="text-align: justify;"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">RSVP Required - Name will be provided!</span></p>
<p style="text-align: justify;"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Location: 50-60 Longwood Ave. Executive Hospitality Room</span> </p>
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<p style="text-align: left;"> </p>
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                              <p><span style="font-size: 20px; color: rgb(155, 214, 74);">RESERVATION</span></p>
                            </td>
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<tr>
                            <td width="22%"><span style="color: rgb(255, 255, 255);"><label>Name: <span class="required">*</span></label></span></td>
                            <td width="28%"><input type="text" tabindex="1" required="true" onfocus_fckprotectedatt="%20onfocus%3D%22if%20(this.value%3D%3D'First%20Name')%20this.value%3D''%22" onblur_fckprotectedatt="%20onblur%3D%22if%20(this.value%3D%3D'')%20this.value%3D'First%20Name'%22" class=" firstname" placeholder="First Name" maxlength="40" size="20" id="firstname" name="x_first_name"><input type="text" tabindex="2" required="true" onfocus_fckprotectedatt="%20onfocus%3D%22if%20(this.value%3D%3D'Last%20Name')%20this.value%3D''%22" onblur_fckprotectedatt="%20onblur%3D%22if%20(this.value%3D%3D'')%20this.value%3D'Last%20Name'%22" class=" lastname" placeholder="Last Name" maxlength="80" size="20" id="lastname" name="x_last_name"></td>
                            <td width="20%"><span style="color: rgb(255, 255, 255);"><label>Email: <span class="required">*</span></label></span></td>
                            <td width="30%"><input type="text" tabindex="3" required="true" value="" maxlength="80" size="20" id="email" name="x_email"></td>
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<tr>
                            <td width="22%"><span style="color: rgb(255, 255, 255);"><label>Select Seats: *</label></span></td>
                            <td width="79%" colspan="3"><select tabindex="4" size="1" name="x_amount"><option selected value="Please Select">Please Select</option>
                                <option value="$25">1 Seat - $25</option>
                                <option value="$50">2 Seats - $50</option>
                                <option value="$75">3 Seats - $75</option>
                                <option value="$180">Sponsor - $180 (Includes 2 Guests)</option></select></td>
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<tr>
                            <td width="22%"><span style="color: rgb(255, 255, 255);"><label>Name of Guest: <span class="required">*</span></label></span></td>
                            <td width="28%"><input type="text" tabindex="5" required="false" onfocus_fckprotectedatt="%20onfocus%3D%22if%20(this.value%3D%3D'First%20Name')%20this.value%3D''%22" onblur_fckprotectedatt="%20onblur%3D%22if%20(this.value%3D%3D'')%20this.value%3D'First%20Name'%22" class=" firstname" placeholder="First Name" maxlength="40" size="20" id="firstname" name="Guest First Name"><input type="text" tabindex="6" required="false" onfocus_fckprotectedatt="%20onfocus%3D%22if%20(this.value%3D%3D'Last%20Name')%20this.value%3D''%22" onblur_fckprotectedatt="%20onblur%3D%22if%20(this.value%3D%3D'')%20this.value%3D'Last%20Name'%22" class=" lastname" placeholder="Last Name" maxlength="80" size="20" id="lastname" name="Guest Last Name"></td>
                            <td width="20%"><span style="color: rgb(255, 255, 255);"><label>Guest Email: <span class="required">*</span></label></span></td>
                            <td width="30%"><input type="text" tabindex="7" required="false" value="" maxlength="80" size="20" id="email" name="Guest Email"></td>
                          </tr>
<tr>
                            <td width="22%"><span style="color: rgb(255, 255, 255);"><label>Credit Card: *</label></span></td>
                            <td width="28%"><input type="text" tabindex="8" required="true" value="" maxlength="100" size="20" id="industry_other" name="x_card_num"></td>
                            <td width="20%"><span style="font-family: 'Trebuchet MS'; color: rgb(255, 255, 255);">Expiration: *</span></td>
                            <td width="30%"><select tabindex="9" name="x_exp_month"><option selected value="Month">Month</option>
                                <option value="01">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><select tabindex="10" name="x_exp_year"><option selected value="Year">Year</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>
                                <option value="2019">2019</option>
                                <option value="2020">2020</option></select></td>
                          </tr>
<tr align="right">
                            <td width="100%" align="right" colspan="4">
                              <div align="center"><span style="color: rgb(255, 255, 255);">Please fill out the following information if you did not fill out the Join / Connect form</span></div>
                            </td>
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<tr>
                            <td width="22%"><span style="color: rgb(255, 255, 255);"><label>Hospital:</label></span></td>
                            <td width="28%"><input type="text" tabindex="11" required="false" value="" maxlength="100" size="20" id="industry_other" name="Hospital"></td>
                            <td width="20%">
                              <font color="#ffffff">Field:</font>
                            </td>
                            <td width="30%"><input type="text" tabindex="12" required="false" value="" maxlength="80" size="20" id="email" name="Field"></td>
                          </tr>
<tr>
                            <td width="22%"><span style="color: rgb(255, 255, 255);"><label>College Graduated:</label></span></td>
                            <td width="28%" class="smallinput"><input type="text" tabindex="13" required="false" value="" maxlength="100" size="20" id="hometown" name="College"></td>
                            <td width="20%"><span style="color: rgb(255, 255, 255);"><label>Hometown:</label></span></td>
                            <td width="30%"><input type="text" tabindex="14" required="false" value="" maxlength="100" size="20" id="currentcity" name="Hometown"></td>
                          </tr>
<tr>
                            <td width="22%" colspan="1"><span style="color: rgb(255, 255, 255);"><label style="margin-right:20px">Age:</label></span></td>
                            <td width="79%" colspan="3" class="radiotd"><span style="color: rgb(255, 255, 255);"><input type="radio" tabindex="15" class="radio" value="21-25" name="Age">21-25 <input type="radio" tabindex="16" class="radio" value="26-31" name="Age">26-31 <input type="radio" tabindex="17" class="radio" value="32-40" name="Age">32-40 </span></td>
                          </tr>
<tr style="">
                            <td width="22%" style=""><span style="color: rgb(255, 255, 255);"><label>Comment:</label></span></td>
                            <td width="79%" style="text-align: left;" colspan="3"><textarea tabindex="18" required="false" rows="8" cols="50" name="comment"></textarea></td>
                          </tr>
<tr align="right">
                            <td width="100%" align="right" colspan="4">
                              <div align="center"><input type="submit" tabindex="1000" name="SubmitCCO" value="Submit"> <input type="reset" name="reset1" id="reset1" tabindex="1001" value="Reset"></div>
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                    <td width="45%" valign="top" align="center" celpadding="15">
                      <table width="310" bgcolor="353535" dir="ltr" style="" cellpadding="5">
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                            <td colspan="2" style="text-align: center;" width="100%">
                              <p><span style="font-family: Arial; font-size: 20px; color: rgb(155, 214, 74);">CHAI MEDICAL COMMITTEE</span></p>
                            </td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">David E. Ruchelsman</span></td>
                            <td width="60%"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Mass General
<br></span> <em><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">M.D. Hand Surgeon</span></em></td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Erica Rose Denhoff</span></td>
                            <td width="60%">
                              <p><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Boston Children's Hospital
<br></span> <font color="#ffffff" face="Arial"><span style="font-size: 14px;"><i>Clinical Reserach</i></span></font>
                              </p>
                            </td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Akiva M. Daum</span></td>
                            <td width="60%">
                              <p><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">BUMC 
<br></span> <font color="#ffffff" face="Arial"><span style="font-size: 14px;"><i>Psychiatry Resident</i></span></font>
                              </p>
                            </td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Itai Pashtan</span></td>
                            <td width="60%"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Dana Farber/Brigham 
<br>
 <i>M.D. Radiation Oncology</i></span></td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Shifra Koyfman</span></td>
                            <td width="60%"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">MGH Children 
<br>
 <i>Pediatric Gastroenterology</i></span></td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Julie B. Dollinger</span></td>
                            <td width="60%"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Harvard Medical 
<br>
 <em>M.D. Clinical Instructor</em> </span></td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Michael H. Sherman</span></td>
                            <td width="60%"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">BUMC 
<br></span></td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Ehsan Saadat</span></td>
                            <td width="60%"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Brigham and Women's  
<br>
 <em>M.D  Orthopedic Surgery</em> </span></td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Oren Berkowitz</span> <span style="font-size: 12px;"><em><span style="color: rgb(255, 255, 255); font-family: Arial;">Phd, MSPH, PA-C</span></em></span></td>
                            <td width="60%"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Assistant Professor of Medicine BUMC</span></td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Jacob Gologorsky</span></td>
                            <td width="60%">
                              <font color="#ffffff" face="Arial"><span style="font-size: 14px;">Harvard Medical School
<br>
 Spine Fellow</span></font>
                            </td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Deborah Heller</span></td>
                            <td width="60%">
                              <p><span style="font-size: 14px; font-family: Arial; color: rgb(255, 255, 255);">BUMC  
<br style="">
 <em style="">Periodontist</em> </span></p>
                            </td>
                          </tr>
<tr>
                            <td width="40%" valign="top"><span style="color: rgb(255, 255, 255); font-size: 14px; font-family: Arial;">Aileen Raizner</span></td>
                            <td width="60%"><span style="font-size: 14px; color: rgb(255, 255, 255); font-family: Arial;">Boston Children's Hospital</span></td>
                          </tr>
                        </tbody>
                      </table>
                    </td>
                  </tr>
                </tbody>
              </table>
            </td>
          </tr>
        </tbody>
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