0916d3332d7cd86d644d2b4fe&amp;id=364a798952" method="post" id="email-subscribe" name="mc-embedded-subscribe-form" class="simple-form wide-form" novalidate data-customvalidate="no-checkbox">

					<fieldset>

						<label for="mce-NAME">Name
						<input type="text" name="NAME" id="mce-NAME" value="{logged_in_screen_name}" required /></label>

						<label for="mce-EMAIL">Email address
						<input type="email" name="EMAIL" id="mce-EMAIL" value="{logged_in_email}" required /></label>

					</fieldset>

					