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<link href="//cdn-images.mailchimp.com/embedcode/classic-061523.css" rel="stylesheet" type="text/css">
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#mc_embed_signup{background:#fff; false;clear:left; font:14px Helvetica,Arial,sans-serif; width: 600px;}
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<div id="mc_embed_signup">
<form action="https://hetnet.us1.list-manage.com/subscribe/post?u=17db9351b700465c3d23d76ec&id=6f2af5c399&f_id=00463be2f0" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank">
<div id="mc_embed_signup_scroll"><h2>Subscribe</h2>
<div class="indicates-required"><span class="asterisk">*</span> indicates required</div>
<div class="mc-field-group"><label for="mce-EMAIL">Email Address <span class="asterisk">*</span></label><input type="email" name="EMAIL" class="required email" id="mce-EMAIL" required="" value=""></div><div class="mc-field-group"><label for="mce-FNAME">First Name <span class="asterisk">*</span></label><input type="text" name="FNAME" class="required text" id="mce-FNAME" required="" value=""></div><div class="mc-field-group"><label for="mce-LNAME">Last Name <span class="asterisk">*</span></label><input type="text" name="LNAME" class="required text" id="mce-LNAME" required="" value=""></div>
<div hidden=""><input type="hidden" name="tags" value="1547958"></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 aria-hidden="true" style="position: absolute; left: -5000px;"><input type="text" name="b_17db9351b700465c3d23d76ec_6f2af5c399" tabindex="-1" value=""></div><div class="clear"><input type="submit" name="subscribe" id="mc-embedded-subscribe" class="button" value="Subscribe"></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';fnames[3]='ADDRESS';ftypes[3]='address';fnames[4]='PHONE';ftypes[4]='phone';fnames[5]='BIRTHDAY';ftypes[5]='birthday';}(jQuery));var $mcj = jQuery.noConflict(true);</script></div>