<div class="mailchimp_inputs_wrap">
	<input type="email" name="EMAIL" class="text_input_field" placeholder="Enter Email" required />
	<input type="submit" class="submit_input_button" value="Sign up" />
</div>
<p class="terms_agree_checkbox_wrap">
    <label class="terms_agree_checkbox" style="color:#fff;">
        <input name="AGREE_TO_TERMS" type="checkbox" value="1" required="">I agree that my submitted data is being collected and stored.</label>
</p>