<form action="https://a5c5e3.emailsp.com/Frontend/subscribe.aspx">
<div >
<h1 >Titolo modulo</h1>
</div>
<div>
<label for="1" >Nome</label>
<input type="text" rel="1" name="campo1" id="campo1" placeholder="" maxlength="200">
<p ></p>
</div>
<div>
<label for="2" >Cognome*</label>
<input type="text" rel="2" name="campo2" id="campo2" placeholder="" maxlength="200" required="required">
<p ></p>
</div>
<div>
<label for="3" >Città*</label>
<input type="text" rel="4" name="campo4" id="campo4" placeholder="" maxlength="200" required="required">
<p ></p>
</div>
<div>
<label for="4" >Data di nascita*</label>
<input type="text" rel="27" name="campo27" id="campo27" placeholder="" maxlength="200" required="required">
<p ></p>
</div>
<div>
<label for="1" >Email*</label>
<input type="email" name="email" id="email" placeholder="Inserisci la tua email" required="required">
<p >Quando invii il modulo, controlla la tua inbox per confermare l'iscrizione</p>
</div>
<div>
<button type="submit" name="submit" value="true" >
Bottone invio
</button>
</div>
<div>
<label for="3" >Privacy*</label>
<div >
<label><input type="checkbox" name="privacy" required="required">Accetto la </label> <a target="_blank" href="http://"> Privacy Policy</a>
</div>
</div>
<input type="hidden" name="list" value="1">

<input type="hidden" id="apgroup" name="apgroup" value="13"></form>