<div class="np-front-subscription"> <div class="form-inputs clearfix"> <h4 class="nps-popup-title">Subscribe at our newsletter</h4> </div> <div class="form-inputs clearfix"> <div id="ajax-errors-subscribe" class="alert alert-danger" style="display: none;"></div> <div class="clear"></div> <div id="ajax-success-subscribe" class="alert alert-success" style="display: none;"></div> <div class="clear"></div> </div> <div class="form-inputs clearfix"> <div class="form-inputs clearfix"> <div class="form-group"><label>Title</label> <div class="clear"> </div> <div class="radio-inline" style="margin-bottom: 0; height: 20px;"> <label for="id_gender1" class="top" style="margin-bottom: 0;"> <input type="radio" name="id_gender" id="id_gender1" class="np-input-radio" value="1" /> Mr. </label> </div> <div class="radio-inline" style="margin-bottom: 0; height: 20px;"> <label for="id_gender2" class="top" style="margin-bottom: 0;"> <input type="radio" name="id_gender" id="id_gender2" class="np-input-radio" value="2" /> Mrs. </label> </div> </div> <div class="form-group"><label>First name</label> <input class="form-control" type="text" name="firstname" value=""> </div> <div class="form-group"><label>Last name</label> <input class="form-control" type="text" name="lastname" value=""> </div> <div class="form-group"><label>Email^*</label> <input id="np-popup-email" class="form-control" type="text" name="email" value=""> </div> <div class="form-group"><label>Date of Birthday</label> <div class="np-row"> <div class="np-col-4"> <div class="select-group"> <select id="np-days" name="days" class="np-select-option"> <option value="">-</option> <option value="1">1&nbsp;&nbsp;</option> <option value="2">2&nbsp;&nbsp;</option> <option value="3">3&nbsp;&nbsp;</option> <option value="4">4&nbsp;&nbsp;</option> <option value="5">5&nbsp;&nbsp;</option> <option value="6">6&nbsp;&nbsp;</option> <option value="7">7&nbsp;&nbsp;</option> <option value="8">8&nbsp;&nbsp;</option> <option value="9">9&nbsp;&nbsp;</option> <option value="10">10&nbsp;&nbsp;</option> <option value="11">11&nbsp;&nbsp;</option> <option value="12">12&nbsp;&nbsp;</option> <option value="13">13&nbsp;&nbsp;</option> <option value="14">14&nbsp;&nbsp;</option> <option value="15">15&nbsp;&nbsp;</option> <option value="16">16&nbsp;&nbsp;</option> <option value="17">17&nbsp;&nbsp;</option> <option value="18">18&nbsp;&nbsp;</option> <option value="19">19&nbsp;&nbsp;</option> <option value="20">20&nbsp;&nbsp;</option> <option value="21">21&nbsp;&nbsp;</option> <option value="22">22&nbsp;&nbsp;</option> <option value="23">23&nbsp;&nbsp;</option> <option value="24">24&nbsp;&nbsp;</option> <option value="25">25&nbsp;&nbsp;</option> <option value="26">26&nbsp;&nbsp;</option> <option value="27">27&nbsp;&nbsp;</option> <option value="28">28&nbsp;&nbsp;</option> <option value="29">29&nbsp;&nbsp;</option> <option value="30">30&nbsp;&nbsp;</option> <option value="31">31&nbsp;&nbsp;</option> </select> </div> </div> <div class="np-col-4"> <div class="select-group"> <select id="np-months" name="months" class="np-select-option"> <option value="">-</option> <option value="01">January&nbsp;</option> <option value="02">February&nbsp;</option> <option value="03">March&nbsp;</option> <option value="04">April&nbsp;</option> <option value="05">May&nbsp;</option> <option value="06">June&nbsp;</option> <option value="07">July&nbsp;</option> <option value="08">August&nbsp;</option> <option value="09">September&nbsp;</option> <option value="10">October&nbsp;</option> <option value="11">November&nbsp;</option> <option value="12">December&nbsp;</option> </select> </div> </div> <div class="np-col-4"> <div class="select-group"> <select id="np-years" name="years" class="np-select-option"> <option value="">-</option> <option value="2018">2018&nbsp;&nbsp;</option> <option value="2017">2017&nbsp;&nbsp;</option> <option value="2016">2016&nbsp;&nbsp;</option> <option value="2015">2015&nbsp;&nbsp;</option> <option value="2014">2014&nbsp;&nbsp;</option> <option value="2013">2013&nbsp;&nbsp;</option> <option value="2012">2012&nbsp;&nbsp;</option> <option value="2011">2011&nbsp;&nbsp;</option> <option value="2010">2010&nbsp;&nbsp;</option> <option value="2009">2009&nbsp;&nbsp;</option> <option value="2008">2008&nbsp;&nbsp;</option> <option value="2007">2007&nbsp;&nbsp;</option> <option value="2006">2006&nbsp;&nbsp;</option> <option value="2005">2005&nbsp;&nbsp;</option> <option value="2004">2004&nbsp;&nbsp;</option> <option value="2003">2003&nbsp;&nbsp;</option> <option value="2002">2002&nbsp;&nbsp;</option> <option value="2001">2001&nbsp;&nbsp;</option> <option value="2000">2000&nbsp;&nbsp;</option> <option value="1999">1999&nbsp;&nbsp;</option> <option value="1998">1998&nbsp;&nbsp;</option> <option value="1997">1997&nbsp;&nbsp;</option> <option value="1996">1996&nbsp;&nbsp;</option> <option value="1995">1995&nbsp;&nbsp;</option> <option value="1994">1994&nbsp;&nbsp;</option> <option value="1993">1993&nbsp;&nbsp;</option> <option value="1992">1992&nbsp;&nbsp;</option> <option value="1991">1991&nbsp;&nbsp;</option> <option value="1990">1990&nbsp;&nbsp;</option> <option value="1989">1989&nbsp;&nbsp;</option> <option value="1988">1988&nbsp;&nbsp;</option> <option value="1987">1987&nbsp;&nbsp;</option> <option value="1986">1986&nbsp;&nbsp;</option> <option value="1985">1985&nbsp;&nbsp;</option> <option value="1984">1984&nbsp;&nbsp;</option> <option value="1983">1983&nbsp;&nbsp;</option> <option value="1982">1982&nbsp;&nbsp;</option> <option value="1981">1981&nbsp;&nbsp;</option> <option value="1980">1980&nbsp;&nbsp;</option> <option value="1979">1979&nbsp;&nbsp;</option> <option value="1978">1978&nbsp;&nbsp;</option> <option value="1977">1977&nbsp;&nbsp;</option> <option value="1976">1976&nbsp;&nbsp;</option> <option value="1975">1975&nbsp;&nbsp;</option> <option value="1974">1974&nbsp;&nbsp;</option> <option value="1973">1973&nbsp;&nbsp;</option> <option value="1972">1972&nbsp;&nbsp;</option> <option value="1971">1971&nbsp;&nbsp;</option> <option value="1970">1970&nbsp;&nbsp;</option> <option value="1969">1969&nbsp;&nbsp;</option> <option value="1968">1968&nbsp;&nbsp;</option> <option value="1967">1967&nbsp;&nbsp;</option> <option value="1966">1966&nbsp;&nbsp;</option> <option value="1965">1965&nbsp;&nbsp;</option> <option value="1964">1964&nbsp;&nbsp;</option> <option value="1963">1963&nbsp;&nbsp;</option> <option value="1962">1962&nbsp;&nbsp;</option> <option value="1961">1961&nbsp;&nbsp;</option> <option value="1960">1960&nbsp;&nbsp;</option> <option value="1959">1959&nbsp;&nbsp;</option> <option value="1958">1958&nbsp;&nbsp;</option> <option value="1957">1957&nbsp;&nbsp;</option> <option value="1956">1956&nbsp;&nbsp;</option> <option value="1955">1955&nbsp;&nbsp;</option> <option value="1954">1954&nbsp;&nbsp;</option> <option value="1953">1953&nbsp;&nbsp;</option> <option value="1952">1952&nbsp;&nbsp;</option> <option value="1951">1951&nbsp;&nbsp;</option> <option value="1950">1950&nbsp;&nbsp;</option> <option value="1949">1949&nbsp;&nbsp;</option> <option value="1948">1948&nbsp;&nbsp;</option> <option value="1947">1947&nbsp;&nbsp;</option> <option value="1946">1946&nbsp;&nbsp;</option> <option value="1945">1945&nbsp;&nbsp;</option> <option value="1944">1944&nbsp;&nbsp;</option> <option value="1943">1943&nbsp;&nbsp;</option> <option value="1942">1942&nbsp;&nbsp;</option> <option value="1941">1941&nbsp;&nbsp;</option> <option value="1940">1940&nbsp;&nbsp;</option> <option value="1939">1939&nbsp;&nbsp;</option> <option value="1938">1938&nbsp;&nbsp;</option> <option value="1937">1937&nbsp;&nbsp;</option> <option value="1936">1936&nbsp;&nbsp;</option> <option value="1935">1935&nbsp;&nbsp;</option> <option value="1934">1934&nbsp;&nbsp;</option> <option value="1933">1933&nbsp;&nbsp;</option> <option value="1932">1932&nbsp;&nbsp;</option> <option value="1931">1931&nbsp;&nbsp;</option> <option value="1930">1930&nbsp;&nbsp;</option> <option value="1929">1929&nbsp;&nbsp;</option> <option value="1928">1928&nbsp;&nbsp;</option> <option value="1927">1927&nbsp;&nbsp;</option> <option value="1926">1926&nbsp;&nbsp;</option> <option value="1925">1925&nbsp;&nbsp;</option> <option value="1924">1924&nbsp;&nbsp;</option> <option value="1923">1923&nbsp;&nbsp;</option> <option value="1922">1922&nbsp;&nbsp;</option> <option value="1921">1921&nbsp;&nbsp;</option> <option value="1920">1920&nbsp;&nbsp;</option> <option value="1919">1919&nbsp;&nbsp;</option> <option value="1918">1918&nbsp;&nbsp;</option> <option value="1917">1917&nbsp;&nbsp;</option> <option value="1916">1916&nbsp;&nbsp;</option> <option value="1915">1915&nbsp;&nbsp;</option> <option value="1914">1914&nbsp;&nbsp;</option> <option value="1913">1913&nbsp;&nbsp;</option> <option value="1912">1912&nbsp;&nbsp;</option> <option value="1911">1911&nbsp;&nbsp;</option> <option value="1910">1910&nbsp;&nbsp;</option> <option value="1909">1909&nbsp;&nbsp;</option> <option value="1908">1908&nbsp;&nbsp;</option> <option value="1907">1907&nbsp;&nbsp;</option> <option value="1906">1906&nbsp;&nbsp;</option> <option value="1905">1905&nbsp;&nbsp;</option> <option value="1904">1904&nbsp;&nbsp;</option> <option value="1903">1903&nbsp;&nbsp;</option> <option value="1902">1902&nbsp;&nbsp;</option> <option value="1901">1901&nbsp;&nbsp;</option> <option value="1900">1900&nbsp;&nbsp;</option> </select> </div> </div> </div> <div class="clear"> </div> </div> <div class="form-group"><label>Are you interested in</label> <div class="select-group"> <select id="np-list-of-interest" name="list_of_interest" class="np-select-option"> <option value="">-</option> </select> </div> </div> </div> <div class="form-inputs clearfix"> <div class="form-group clearfix" style="margin-bottom: 0;"> <a href="#" id="submit-newsletterpro-subscribe" class="np-button submit-newsletterpro-subscribe"> <span>Subscribe</span> </a> <a href="javascript:{}" id="newsletterpro-subscribe-close-forever" class="close-forever"> <span>Don't show next time.</span> </a> <div class="clear"> </div> </div> </div> <div class="clear"></div> </div> <div class="clear"></div> </div>