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<div id=”mc_embed_signup_scroll”><h2>Ricevi promo prima di tutti</h2>
<div class=”indicates-required”><span class=”asterisk”>*</span> indica requisiti obbligatori</div>
<div class=”mc-field-group”><label for=”mce-EMAIL”>Indirizzo email <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”>Nome </label><input type=”text” name=”FNAME” class=” text” id=”mce-FNAME” value=””></div><div class=”mc-field-group”><label for=”mce-LNAME”>Cognome </label><input type=”text” name=”LNAME” class=” text” id=”mce-LNAME” value=””></div><div class=”mc-field-group”><label for=”mce-PHONE”>Numero di telefono </label><input type=”text” name=”PHONE” class=”REQ_CSS” id=”mce-PHONE” value=””><span id=”mce-PHONE-HELPERTEXT” class=”helper_text”>se non leggi le email e vuoi riceverle via sms</span></div><div class=”mc-field-group”><label for=”mce-MMERGE6″>Che utente sei? <span class=”asterisk”>*</span></label><select name=”MMERGE6″ class=”required” id=”mce-MMERGE6″><option value=””></option><option value=”Sig.”>Sig.</option><option value=”Sig.ra”>Sig.ra</option><option value=”Dott.”>Dott.</option><option value=”Dott.ssa”>Dott.ssa</option></select></div><div class=”mc-field-group input-group”><strong>i tuoi interessi <span class=”asterisk”>*</span></strong><ul><li><input type=”radio” name=”MMERGE7″ id=”mce-MMERGE70″ value=”Eventi in farmacia”><label for=”mce-MMERGE70″>Eventi in farmacia</label></li><li><input type=”radio” name=”MMERGE7″ id=”mce-MMERGE71″ value=”Cosmesi”><label for=”mce-MMERGE71″>Cosmesi</label></li><li><input type=”radio” name=”MMERGE7″ id=”mce-MMERGE72″ value=”Medicina Estetica”><label for=”mce-MMERGE72″>Medicina Estetica</label></li><li><input type=”radio” name=”MMERGE7″ id=”mce-MMERGE73″ value=”Trattamenti di Bellezza”><label for=”mce-MMERGE73″>Trattamenti di Bellezza</label></li><li><input type=”radio” name=”MMERGE7″ id=”mce-MMERGE74″ value=”Hyaluron Pen”><label for=”mce-MMERGE74″>Hyaluron Pen</label></li><li><input type=”radio” name=”MMERGE7″ id=”mce-MMERGE75″ value=”Acquisti online”><label for=”mce-MMERGE75″>Acquisti online</label></li></ul></div>
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