<div id="mc_embed_signup" class="col-md-6">
<form id="mc-embedded-subscribe-form" class="validate" action="//EDU.us13.list-manage.com/subscribe/post?u=93d3960406f5fb4f5098f1bb6&id=a2cda39a16" method="post" name="mc-embedded-subscribe-form" novalidate="" target="_blank">
<div id="mc_embed_signup_scroll">
<div class="indicates-required mb-3"><span class="text-danger">*</span> indicates required field</div>
<div class="mc-field-group mb-3">
<label class="form-label" for="mce-EMAIL">Email Address  <span class="text-danger">*</span></label><br />
<input type="email" value="" name="EMAIL" class="required email form-control" id="mce-EMAIL" aria-required="true" autocomplete="off">
</div>
<div class="mc-field-group mb-3">
<label class="form-label" for="mce-FNAME">First Name </label><br />
<input type="text" value="" name="FNAME" class="form-control" id="mce-FNAME">
</div>
<div class="mc-field-group mb-3">
<label class="form-label" for="mce-LNAME">Last Name </label><br />
<input type="text" value="" name="LNAME" class="form-control" id="mce-LNAME">
</div>
<div id="mce-responses" class="clear">
<div id="mce-error-response" class="response" style="display: none;"></div>
<div id="mce-success-response" class="response" style="display: none;"></div>
</div>
<p></p>
<div class="d-none invisible" aria-hidden="true"><input tabindex="-1" name="b_93d3960406f5fb4f5098f1bb6_a2cda39a16" type="text" value="" /></div>
<div class="clear"><input id="mc-embedded-subscribe" class="btn btn-primary" name="subscribe" type="submit" value="Subscribe" /></div>
</div>
</form>
</div>
<p></p>

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