<p>
	<input type="email" name="EMAIL" placeholder="Your email address" required />
</p>

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

<p class="terms_agree_checkbox_wrap">
    <label class="terms_agree_checkbox">
        <input name="AGREE_TO_TERMS" type="checkbox" value="1" required="">I agree that my submitted data is being collected and stored.</label>
</p>