lb-mailchimp.php

<div id="mailchimp" class="mpopup mailchimp fill">
	<div class="container">
		<!-- Begin MailChimp Signup Form -->
		<div id="mc_embed_signup">
				<form
				action="//boilermaker.us10.list-manage.com/subscribe/post?u=9761ac931e45803979238b79b&amp;id=bbe2e0556e"
				method="post"
				id="mc-embedded-subscribe-form"
				name="mc-embedded-subscribe-form"
				class="validate"
				target="_blank"
				novalidate
				>
					<div id="mc_embed_signup_scroll">
						<h2 class="cusborder down">health arc newsletter</h2>
						<!-- <p>Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo. Nemo enim ipsam voluptatem quia voluptas sit aspernatur aut odit aut fugit, sed quia consequuntur magni...</p> -->
						<div class="row">
							<div class="columns medium-6">
								<div class="mc-field-group">
									<label>first name</label>
									<input type="text" value="" name="FNAME" class="" id="mce-FNAME" placeholder="">
								</div>
							</div>
							<div class="columns medium-6">
								<div class="mc-field-group">
									<label>last name</label>
									<input type="text" value="" name="LNAME" class="" id="mce-LNAME" placeholder="">
								</div>
							</div>
						</div>
						<div class="row">
							<div class="columns">
								<div class="mc-field-group">
									<label>email</label>
									<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL" placeholder="">
								</div>
							</div>
						</div>
						<div class="row">
							<div class="columns">
								<div id="mce-responses" class="clear">
									<div class="response" id="mce-error-response" style="display:none"></div>
									<div class="response" id="mce-success-response" style="display:none"></div>
								</div>
							</div>
						</div>
				    <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
						<div style="position: absolute; left: -5000px;">
							<input type="text" name="b_bc7c4ee2e6cd6c4feb3876fd1_07a2a4aa69" tabindex="-1" value="">
						</div>
						<div class="row">
							<div class="columns">
								<input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="btn primary">
							</div>
						</div>
					</div>
				</form>
		</div>
		<!--End mc_embed_signup-->
	</div>
</div>


<script type='text/javascript' src='//s3.amazonaws.com/downloads.mailchimp.com/js/mc-validate.js'></script><script type='text/javascript'>(function($) {window.fnames = new Array(); window.ftypes = new Array();fnames[0]='EMAIL';ftypes[0]='email';fnames[1]='FNAME';ftypes[1]='text';fnames[2]='LNAME';ftypes[2]='text';}(jQuery));var $mcj = jQuery.noConflict(true);</script>
<!--End mc_embed_signup-->