<!-- Le code ci-dessous a été réalisé pour le compte Websico, seulement pour exemple. Vous devez utiliser le générateur Mailchimp pour votre propre compte -->

<!-- Styles - Add your own MailChimp form style overrides in your site stylesheet or in this style block. */ -->
<link href="//cdn-images.mailchimp.com/embedcode/classic-081711.css" rel="stylesheet" type="text/css">
<style>
    #mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; }
</style>

<!-- The HTML block -->
<div id="mc_embed_signup">
<form action="//websico.us4.list-manage.com/subscribe/post?u=814fd0a1f5c02a7019a033f3e&amp;id=6ac7a9d020" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
    <h2>Subscribe to our mailing list</h2>
<div class="indicates-required"><span class="asterisk">*</span> indicates required</div>
<div class="mc-field-group">
    <label for="mce-EMAIL">Email  <span class="asterisk">*</span>
</label>
    <input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
    <label for="mce-FNAME">First Name </label>
    <input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
    <label for="mce-LNAME">Last Name </label>
    <input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</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>
</div>