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    <form action="https://bezenandcreative.us21.list-manage.com/subscribe/post?u=e7438ee455efe190df20a58f2&amp;id=5420f7aefc&amp;f_id=00a558e1f0" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank">
        <div id="mc_embed_signup_scroll"><h2>Laissez-nous votre plus belle adresse pour en savoir plus sur nous!</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 </label><input type="text" name="FNAME" class=" text" id="mce-FNAME" value=""></div><div class="mc-field-group"><label for="mce-LNAME">Last Name </label><input type="text" name="LNAME" class=" text" id="mce-LNAME" value=""></div><div class="mc-field-group size1of2"><label for="mce-BIRTHDAY-month">Birthday </label><div class="datefield"><span class="subfield monthfield"><input class="birthday REQ_CSS" type="text" pattern="[0-9]*" placeholder="MM" size="2" maxlength="2" name="BIRTHDAY[month]" id="mce-BIRTHDAY-month" value=""></span> /<span class="subfield dayfield"><input class="birthday REQ_CSS" type="text" pattern="[0-9]*" placeholder="DD" size="2" maxlength="2" name="BIRTHDAY[day]" id="mce-BIRTHDAY-day" value=""></span><span class="small-meta nowrap">( mm / dd )</span></div></div>
<div hidden=""><input type="hidden" name="tags" value="2818508,2818509,2818510,2818513,2818514,2818511"></div>
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