choices-mc

    <!-- Begin MailChimp Signup Form -->
    <div id="mc_embed_signup">
    <h2>Mailing List</h2>
 <!-- Begin MailChimp Signup Form -->

<form action="http://choices.us1.list-manage.com/subscribe/post?u=7f9892a0a1c9a0f456b6bd94b&amp;id=af2c96b5f0" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate="">

<div class="mc-field-group">
    <label for="mce-EMAIL">Email Address*</label>
    <input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL" placeholder="ex: j.carberry@brown.edu">
</div>
<div class="mc-field-group">
    <label for="FNAME">First Name*</label>
    <input type="text" value="" name="FNAME" class="required" id="mce-FNAME" placeholder="ex: Josiah">
</div>

<div class="accordion">
    <div class="mc-field-group">
        <label for="LNAME">Last Name</label>
        <input type="text" value="" name="LNAME" class="" id="mce-LNAME" placeholder="ex: Carberry">
    </div>
    <div class="mc-address-group">
        <label for="MMERGE3[addr1]">Mailing Address</label>
        <div class="mc-field-group">
            <input type="text" value="" maxlength="70" name="MMERGE3[addr1]" id="mce-MMERGE3-addr1" class="" placeholder="ex: 15 Main St.">
        </div>
        <div class="mc-field-group size1of2">
        <label for="MMERGE3[city]">City</label>
            <input type="text" value="" maxlength="40" name="MMERGE3[city]" id="mce-MMERGE3-city" class="" placeholder="ex: Providence">
        </div>
        <div class="mc-field-group size1of2">
        <label for="MMERGE3[state]">State</label>
            <input type="text" value="" maxlength="20" name="MMERGE3[state]" id="mce-MMERGE3-state" class="" placeholder="ex: RI">
        </div>
        <div class="mc-field-group size1of2">
        <label for="MMERGE3[zip]">Zip Code</label>
                <input type="text" value="" maxlength="10" name="MMERGE3[zip]" id="mce-MMERGE3-zip" class="" placeholder="ex: 02903">
        </div>
        </div>

    <div class="mc-field-group input-group">
        <strong>Would you like us to send you a catalog? </strong>
        <ul><li><input type="checkbox" value="128" name="group[21][128]" id="mce-group[21]-21-0">
        <label for="mce-group[21]-21-0">Yes, please</label></li>
    <li><input type="checkbox" value="256" name="group[21][256]" id="mce-group[21]-21-1">
    <label for="mce-group[21]-21-1">No, thank you</label></li>
    </ul>
</div>
</div>
    <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 class="clear"><input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</form>

<!--End mc_embed_signup-->