<!-- Begin MailChimp Signup Form --><!-- [et_pb_line_break_holder] --><link href="//cdn-images.mailchimp.com/embedcode/classic-10_7.css" rel="stylesheet" type="text/css"><!-- [et_pb_line_break_holder] --><style type="text/css"><!-- [et_pb_line_break_holder] --> #mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; }<!-- [et_pb_line_break_holder] --> /* Add your own MailChimp form style overrides in your site stylesheet or in this style block.<!-- [et_pb_line_break_holder] --> We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. */<!-- [et_pb_line_break_holder] --></style><!-- [et_pb_line_break_holder] --><div id="mc_embed_signup"><!-- [et_pb_line_break_holder] --><form action="https://thecaregiverspace.us7.list-manage.com/subscribe/post?u=b310c0129e56a964db28e1d05&id=c9c686caf6" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate><!-- [et_pb_line_break_holder] --> <div id="mc_embed_signup_scroll"><!-- [et_pb_line_break_holder] --> <h2>Subscribe to our mailing list</h2><!-- [et_pb_line_break_holder] --><div class="indicates-required"><span class="asterisk">*</span> indicates required</div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-EMAIL">Email Address <span class="asterisk">*</span><!-- [et_pb_line_break_holder] --></label><!-- [et_pb_line_break_holder] --> <input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-FNAME">First Name <span class="asterisk">*</span><!-- [et_pb_line_break_holder] --></label><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="FNAME" class="required" id="mce-FNAME"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group input-group"><!-- [et_pb_line_break_holder] --> <strong>How would you describe yourself? </strong><!-- [et_pb_line_break_holder] --> <ul><li><input type="checkbox" value="1024" name="group[10433][1024]" id="mce-group[10433]-10433-0"><label for="mce-group[10433]-10433-0">I'm a young caregiver (under 35ish)</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="2048" name="group[10433][2048]" id="mce-group[10433]-10433-1"><label for="mce-group[10433]-10433-1">I'm a long-term or 24/7 caregiver</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="4096" name="group[10433][4096]" id="mce-group[10433]-10433-2"><label for="mce-group[10433]-10433-2">I'm no longer caregiving at the moment</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="8192" name="group[10433][8192]" id="mce-group[10433]-10433-3"><label for="mce-group[10433]-10433-3">I'm provide care occasionally, from a distance, or mostly coordinate care</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="16384" name="group[10433][16384]" id="mce-group[10433]-10433-4"><label for="mce-group[10433]-10433-4">I'm a professional caregiver for clients</label></li><!-- [et_pb_line_break_holder] --></ul><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><p><a href="https://us7.campaign-archive.com/home/?u=b310c0129e56a964db28e1d05&id=c9c686caf6" title="View previous campaigns">View previous campaigns.</a></p><!-- [et_pb_line_break_holder] --><p>Powered by <a href="http://eepurl.com/4-eyD" title="MailChimp - email marketing made easy and fun">MailChimp</a></p><!-- [et_pb_line_break_holder] --> <div id="mce-responses" class="clear"><!-- [et_pb_line_break_holder] --> <div class="response" id="mce-error-response" style="display:none"></div><!-- [et_pb_line_break_holder] --> <div class="response" id="mce-success-response" style="display:none"></div><!-- [et_pb_line_break_holder] --> </div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups--><!-- [et_pb_line_break_holder] --> <div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_b310c0129e56a964db28e1d05_c9c686caf6" tabindex="-1" value=""></div><!-- [et_pb_line_break_holder] --> <div class="clear"><input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button"></div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --></form><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><script type='text/javascript' src='//s3.amazonaws.com/downloads.mailchimp.com/js/mc-validate.js'></script><script type='text/javascript'>(function($) {window.fnames = new Array(); window.ftypes = new Array();fnames[0]='EMAIL';ftypes[0]='email';fnames[1]='FNAME';ftypes[1]='text';fnames[2]='LNAME';ftypes[2]='text';fnames[3]='MMERGE3';ftypes[3]='text';fnames[4]='MMERGE4';ftypes[4]='url';}(jQuery));var $mcj = jQuery.noConflict(true);</script><!-- [et_pb_line_break_holder] --><!--End mc_embed_signup-->