<div class="col-12 col-sm-12 col-lg-12">
                            <form role="form" id="feedbackForm" method="POST">
                                            <div class="col-lg-6">
                                              <div class="form-group">
                                                <label class="control-label" for="textinput">First Name<span class="required">*</span></label>
                                                <input type="text" class="form-control required" id="first_name" name="first_name" placeholder="Enter your First Name"/>
                                                <span class="help-block" style="display: none;">Please enter your first name.</span>
                                              </div>
                                              <div class="form-group">
                                                <label class="control-label" for="textinput">Last Name<span class="required">*</span></label>
                                                <input type="text" class="form-control" id="last_name" name="last_name" placeholder="Enter your Last Name"/>
                                                <span class="help-block" style="display: none;">Please enter your last name.</span>
                                              </div>
                                              <div class="form-group">
                                                <label class="control-label" for="textinput">Email Address<span class="required">*</span></label>
                                                <input type="email" class="form-control" id="email" name="email" placeholder="Enter your email address"/>
                                                <span class="help-block" style="display: none;">Please enter a valid e-mail address.</span>
                                              </div>
                                              <div class="form-group">
                                                <label class="control-label" for="textinput">Company Name</label>
                                                <input type="email" class="form-control" id="company_name" name="company_name" placeholder="Enter your company name"/>
                                              </div>
                                              <div class="form-group">
                                                <label class="control-label" for="textinput">Message<span class="required">*</span></label>
                                                <textarea rows="10" cols="100" class="form-control" id="message" name="message" placeholder="Enter your message"></textarea>
                                                <span class="help-block" style="display: none;">Please enter a message.</span>
                                              </div>
                                              </div>
                                              <div class="col-lg-6">
                                                <div class="form-group">
                                                  <label for="selectbasic">How did you hear about us?</label>
                                                  <select id="selectbasic" name="selectbasic" class="form-control">
                                                    <option>Select</option>
                                                    <option value="Search Engine">Search engine</option>
                                                    <option value="Microsoft DPE">Microsoft DPE</option>
                                                    <option value="Microsoft Event">Microsoft event</option>
                                                    <option value="Social Media">Social media</option>
                                                    <option value="Word of Mouth">Word of mouth</option>
                                                    <option value="Other">Other</option>
                                                  </select>
                                                </div>
                                                <div class="checkbox">
                                                    <label>
                                                        <input type="checkbox" id="emailUpdates" name="emailUpdates" value="Yes"> Please keep me informed of kinectAPI product updates and news
                                                    </label>
                                                </div>
                                              <img id="captcha" src="library/vender/securimage/securimage_show.php" alt="CAPTCHA Image" />
                                              <a href="#" onclick="document.getElementById('captcha').src = 'library/vender/securimage/securimage_show.php?' + Math.random(); return false" class="btn btn-green btn-sm">Show a Different Image</a><br/>
                                              <div class="form-group" style="margin-top: 10px;">
                                                <input type="text" class="form-control" name="captcha_code" id="captcha_code" placeholder="For security, please enter the code displayed in the box." />
                                                <span class="help-block" style="display: none;">Please enter the code displayed within the image.</span>
                                              </div>

                                              <span class="help-block" style="display: none;">Please enter a the security code.</span>
                                              <button type="submit" id="feedbackSubmit" class="btn btn-purple btn-md message-btn">Submit Message</button>
                                            </div>
                            </form>

                            <?php

                            // SUBSCRIBE TO MAILING LIST OPTION - ADD TO MAILCHIMP USING API
                            if ($_POST['emailUpdates'] == 'Yes')
                            {
                                // Include Mailchimp API class
                                require_once('MCAPI.class.php');

                                // Your API Key: http://admin.mailchimp.com/account/api/
                                $api = new MCAPI('feaf699f7a15c1ca27f6903152d4a3f1-us3');

                                // Your List Unique ID: http://admin.mailchimp.com/lists/ (Click "settings")
                                $list_id = "69010111da";

                                // Variables in your form that match up to variables on your subscriber
                                // list. You might have only a single 'name' field, no fields at all, or more
                                // fields that you want to sync up.
                                $merge_vars = array(
                                    'FNAME' => $_POST['first_name'],
                                    'LNAME' => $_POST['last_name']
                                );

                                // SUBSCRIBE TO LIST
                                if ( $api->listSubscribe($list_id, $_POST['email'], $merge_vars) === true ){
                                    $mailchimp_result = 'Success! Check your email to confirm sign up.';
                                } else {
                                    $mailchimp_result = 'Error: ' . $api->errorMessage;
                                }
                            }

                            ?>
                      </div>