<div class="pop-up newsletter mcSubscribeFormWrapper"><div class="mc_custom_border_hdr">Sign up for Restart, Inc. List</div> <style> .widget_mailchimpsf_widget .widget-title { line-height: 1.4em; margin-bottom: 0.75em; } #mc_subheader { line-height: 1.25em; margin-bottom: 18px; } .mc_merge_var { margin-bottom: 1.0em; } .mc_var_label, .mc_interest_label { display: block; margin-bottom: 0.5em; } .mc_input { -moz-box-sizing: border-box; -webkit-box-sizing: border-box; box-sizing: border-box; width: 100%; } .mc_input.mc_phone { width: auto; } select.mc_select { margin-top: 0.5em; width: 100%; } .mc_address_label { margin-top: 1.0em; margin-bottom: 0.5em; display: block; } .mc_address_label ~ select { width: 100%; } .mc_list li { list-style: none; background: none !important; } .mc_interests_header { margin-top: 1.0em; margin-bottom: 0.5em; } .mc_interest label, .mc_interest input { margin-bottom: 0.4em; } #mc_signup_submit { margin-top: 1.5em; width: 80%; } #mc_unsub_link a { font-size: 0.75em; } #mc_unsub_link { margin-top: 1.0em; } .mc_header_address, .mc_email_format { display: block; font-weight: bold; margin-top: 1.0em; margin-bottom: 0.5em; } .mc_email_options { margin-top: 0.5em; } .mc_email_type { padding-left: 4px; } </style> <div id="mc_signup"> <form method="post" action="#mc_signup" id="mc_signup_form"> <input type="hidden" id="mc_submit_type" name="mc_submit_type" value="html" /> <input type="hidden" name="mcsf_action" value="mc_submit_signup_form" /> <input type="hidden" id="_mc_submit_signup_form_nonce" name="_mc_submit_signup_form_nonce" value="836fd31385" /> <div id="mc_subheader"> To sign up for our email list, enter your email address in the box below </div> <div class="mc_form_inside"> <div class="updated" id="mc_message"> </div> <div class="mc_merge_var"> <label for="mc_mv_EMAIL" class="mc_var_label mc_header mc_header_">Email Address</label> <input type="text" size="18" placeholder="" name="mc_mv_EMAIL" id="mc_mv_EMAIL" class="mc_input"/> </div> <div class="mc_merge_var"> <label for="mc_mv_FNAME" class="mc_var_label mc_header mc_header_">First Name</label> <input type="text" size="18" placeholder="" name="mc_mv_FNAME" id="mc_mv_FNAME" class="mc_input"/> </div> <div class="mc_merge_var"> <label for="mc_mv_LNAME" class="mc_var_label mc_header mc_header_">Last Name</label> <input type="text" size="18" placeholder="" name="mc_mv_LNAME" id="mc_mv_LNAME" class="mc_input"/> </div> <div id="mc-indicates-required"> * = required field </div> <div class="mc_signup_submit"> <input type="submit" name="mc_signup_submit" id="mc_signup_submit" value="Subscribe" class="button" /> </div> </div> </form> </div> </div>Newsletter