<table border="0" bordercolor="0" cellspacing="0" width="100%">
<tr>
<td class="textStyle" width="16%">
<p> <font face="Arial, Helvetica, sans-serif"></font> </p>
</td>
<td class="textStyle" width="17%"> </td>
<td class="textStyle" width="17%">
<h5> </h5>
</td>
<td class="textStyle" width="25%"> </td>
<td class="textStyle" width="25%"> </td>
</tr>
<tr>
<td class="textStyle" colspan="2"><font color="#000000" face="Arial, Helvetica, sans-serif" size="-1"><b>Budget
details</b></font><font face="Arial, Helvetica, sans-serif" size="-1"><b>:</b>
</font>
<hr>
</td>
<td class="textStyle"> </td>
<td class="textStyle"><font face="Arial, Helvetica, sans-serif"></font></td>
<td class="textStyle"><font face="Arial, Helvetica, sans-serif"></font></td>
</tr>
<tr>
<td colspan=3 class="textStyle" bgcolor="#FFCC00">
<div align="left"> <font face="Arial, Helvetica, sans-serif" size="-1">
<input type="radio" name="Member_in" value="Hadassah Staff" class="radioStyle">
<b>Hadassah staff</b></font></div>
</td>
<td colspan=2 class="textStyle" bgcolor="#8CC68C">
<div align="left"><font face="Arial, Helvetica, sans-serif" size="-1">
<input type="radio" name="Member_in" value="Hebrew University Staff" class="radioStyle">
<b>Hebrew University staff</b></font></div>
</td>
</tr>
<tr>
<td colspan="3" class="textStyle" bgcolor="#FFCC00"><font face="Arial, Helvetica, sans-serif" size="-1">Please
charge the following budget number: </font></td>
<td colspan=2 class="textStyle" bgcolor="#8CC68C"><font face="Arial, Helvetica, sans-serif" size="-1">Please
charge the following budget number:</font></td>
</tr>
<tr>
<td bgcolor="#FFCC00" class="textStyle"><font size="-1" face="Arial, Helvetica, sans-serif">Research
Grant</font></td>
<td class="textStyle" bgcolor="#FFCC00" colspan="2"> <font face="Arial, Helvetica, sans-serif" size="-1">
<input name=resGrantPt1 onKeyUp="skipTextboxIfMaxChrs(document.form1.resGrantPt1.value,resGrantPt2,3)" type="text" size="4" maxlength="3">
<b>.</b>
<input name=resGrantPt2 onKeyUp="skipTextboxIfMaxChrs(document.form1.resGrantPt2.value,resGrantPt3,3)" type="text" size="4" maxlength="3">
/
<input name=resGrantPt3 onKeyUp="skipTextboxIfMaxChrs(document.form1.resGrantPt3.value,Medline_source,1)" type="text" size="2" maxlength="1">
</font></td>
<td class="textStyle" bgcolor="#8CC68C" valign="bottom"> <font face="Arial, Helvetica, sans-serif" size="-1">
<input name=hujiGrantPt1 type="text" onKeyUp="skipTextboxIfMaxChrs(document.form1.hujiGrantPt1.value,document.form1.hujiGrantPt2,3)" size="4" maxlength="3">
<b>.</b>
<input name=hujiGrantPt2 type="text" onKeyUp="skipTextboxIfMaxChrs(document.form1.hujiGrantPt2.value,document.form1.hujiGrantPt3,4)" size="5" maxlength="4">
<b>.</b> </font></td>
<td class="textStyle" bgcolor="#8CC68C" valign="bottom"> <font face="Arial, Helvetica, sans-serif" size="-1">
<select name="hujiGrantPt3">
<option value="311">311</option>
<option value="344">344</option>
</select>
</font></td>
</tr>
<tr>
<td bgcolor="#FFCC00" class="textStyle"><font size="-1" face="Arial, Helvetica, sans-serif">Keren
"Sharap"</font></td>
<td class="textStyle" bgcolor="#FFCC00" colspan="2"> <font face="Arial, Helvetica, sans-serif" size="-1">
<input name=kerenSharap type="text" >
</font></td>
<td bgcolor="#8CC68C" class="textStyle" colspan="2"><font size="-1" face="Arial, Helvetica, sans-serif">Other
source
<input name=hujiOtherBudget type="text">
</font> </td>
</tr>
<tr>
<td bgcolor="#FFCC00" class="textStyle"><font size="-1" face="Arial, Helvetica, sans-serif">Keren
"Madrich"</font></td>
<td class="textStyle" bgcolor="#FFCC00" colspan="2"> <font face="Arial, Helvetica, sans-serif" size="-1">
<input name=kerenMadrich type="text">
</font></td>
<td colspan=2 class="textStyle" bgcolor="#8CC68C"> <font face="Arial, Helvetica, sans-serif" size="-1"></font>
</td>
</tr>
<tr>
<td bgcolor="#FFCC00" class="textStyle"><font size="-1" face="Arial, Helvetica, sans-serif">Other
source</font></td>
<td class="textStyle" bgcolor="#FFCC00" colspan="2"> <font face="Arial, Helvetica, sans-serif" size="-1">
<input name=hadassahOtherBudget type="text">
</font></td>
<td colspan=2 class="textStyle" bgcolor="#8CC68C">
<p><font face="Arial, Helvetica, sans-serif"><font size="-1"> </font></font>
</p>
</td>
</tr>
<tr>
<td bgcolor="#FFCC00" class="textStyle" colspan="3"><font size="-1" face="Arial, Helvetica, sans-serif">
<input type="checkbox" name="no_Budget" class="checkBoxStyle" value="I have no budget number">
I don't have budget number </font></td>
<td colspan=2 class="textStyle" bgcolor="#8CC68C">
<p><font size="-1" face="Arial, Helvetica, sans-serif">
<input type="checkbox" name="no_Budget" class="checkBoxStyle" value="I have no budget number">
I don't have budget number </font> </p>
</td>
</tr>
</table>