<!-- Begin MailChimp Signup Form -->
<link href="//cdn-images.mailchimp.com/embedcode/classic-10_7.css" rel="stylesheet" type="text/css">
<style type="text/css">
	#mc_embed_signup{
		/*background:rgba(0, 0, 0, 0.3); */
		clear:left; 
		font:14px Helvetica,Arial,sans-serif; 
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	#mc_embed_signup .mc-field-group{
		width:100%;
	}
	
	#mc_embed_signup #mc-embedded-subscribe-form div.mce_inline_error{
		display:none !important;
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	#mc_embed_signup .mc-field-group label{
		display:inline-block; 
		width:36%; 
		padding:0px 0px 6px 8px; 
		background-color:#e7e7e7;
		border: 1px solid #d5d5d5;
		border-radius: 3px;
		border-right: 0px;
	}
	
	#mc_embed_signup .mc-field-group input{
		display:inline-block; width:57%;
	}
	
	#mc-embedded-subscribe{
		margin: 0px 0px 1rem 0px;
	}
</style>

<div id="mc_embed_signup">
	<form action="https://wgh.us10.list-manage.com/subscribe/post?u=b156f6a97a1e6f901e901414e&id=8e31cf0fb4" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
		<div id="mc_embed_signup_scroll">
			<p><strong>SIGN UP TODAY</strong> for Woodstock Hospital's newsletter.</p>
			
			<div class="indicates-required"><span class="asterisk">*</span> indicates required</div>
			
			<div class="mc-field-group">
				<label for="mce-EMAIL" class="form-label">Email Address  <span class="asterisk">*</span></label>
				<input type="email" value="" name="EMAIL" class="required email form-field" id="mce-EMAIL">
			</div>
			
			<div class="mc-field-group">
				<label for="mce-FNAME">First Name  <span class="asterisk">*</span></label>
				<input type="text" value="" name="FNAME" class="required" id="mce-FNAME">
			</div>
			
			<div class="mc-field-group">
				<label for="mce-LNAME">Last Name  <span class="asterisk">*</span></label>
				<input type="text" value="" name="LNAME" class="required" 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>    <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
			
			<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_a6d26683af7b555bc366970d4_42ff31e4ae" tabindex="-1" value=""></div>
			
			<div class="clear"><input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="aui-button action-button action-button-386493961"></div>
		</div>
	</form>
</div>

<script type='text/javascript' src='//s3.amazonaws.com/downloads.mailchimp.com/js/mc-validate.js'></script>
<script type='text/javascript'>
	(function($) {
		window.fnames = new Array(); 
		window.ftypes = new Array();
		fnames[0]='EMAIL';
		ftypes[0]='email';
		fnames[1]='FNAME';
		ftypes[1]='text';
		fnames[2]='LNAME';
		ftypes[2]='text';
	}(jQuery));
	var $mcj = jQuery.noConflict(true);
</script>
<!--End mc_embed_signup-->