<p>
    <label>First Name:</label>
    <input type="text" name="FNAME" placeholder="Your first name">
</p><p>
	<label for="mc4wp_email">Email address: </label>
	<input type="email" id="mc4wp_email" name="EMAIL" placeholder="Your email address" required />
</p>

<p>
	<input type="submit" value="Sign up" />
</p>