<!--Begin CTCT Sign-Up Form-->
<!-- EFD 1.0.0 [Fri Oct 28 10:20:06 EDT 2016] -->
<link rel="stylesheet" type="text/css" href="https://static.ctctcdn.com/h/contacts-embedded-signup-assets/1.0.2/css/signup-form.css">
<div class="ctct-embed-signup" style="font: 16px Helvetica Neue, Arial, sans-serif; font: 1rem Helvetica Neue, Arial, sans-serif; line-height: 1.5; -webkit-font-smoothing: antialiased;">
<div style="color:#5b5b5b; background-color:#FFFFFF; border-radius:5px;">
<span id="success_message" style="display:none;">
<div style="text-align:center;">Thanks for signing up!</div>
</span>
<form data-id="embedded_signup:form" class="ctct-custom-form Form" name="embedded_signup" method="POST" action="https://visitor2.constantcontact.com/api/signup">
<h2 style="margin:0;">Sign up to stay in touch!</h2>
<p>Sign up to get interesting news, special offers and updates delivered to your inbox.</p>
<!-- The following code must be included to ensure your sign-up form works properly. -->
<input data-id="ca:input" type="hidden" name="ca" value="afb346d4-f6b8-4307-8722-5434fecbbaff">
<input data-id="list:input" type="hidden" name="list" value="1080675086">
<input data-id="source:input" type="hidden" name="source" value="EFD">
<input data-id="required:input" type="hidden" name="required" value="list,email">
<input data-id="url:input" type="hidden" name="url" value="">
<p data-id="Email Address:p"><label data-id="Email Address:label" data-name="email" class="ctct-form-required">Email Address</label> <input data-id="Email Address:input" type="text" name="email" value="" maxlength="80"></p>
<p data-id="First Name:p"><label data-id="First Name:label" data-name="first_name">First Name</label> <input data-id="First Name:input" type="text" name="first_name" value="" maxlength="50"></p>
<button type="submit" class="Button ctct-button Button--block Button-secondary" data-enabled="enabled">Sign Up</button>
<div><p class="ctct-form-footer">By submitting this form, you are granting: Daily Health, 17 Veronica Avenue, Salem, New Hampshire, 03079, United States, http://www.shopdhi.com/ permission to email you. You may unsubscribe via the link found at the bottom of every email. (See our <a href="http://www.constantcontact.com/legal/privacy-statement" target="_blank">Email Privacy Policy</a> for details.) Emails are serviced by Constant Contact.</p></div>
</form>
</div>
</div>
<script type="text/javascript">
var localizedErrMap = {};
localizedErrMap['required'] = 'This field is required.';
localizedErrMap['ca'] = 'An unexpected error occurred while attempting to send email.';
localizedErrMap['email'] = 'Please enter your email address in name@email.com format.';
localizedErrMap['birthday'] = 'Please enter birthday in MM/DD format.';
localizedErrMap['anniversary'] = 'Please enter anniversary in MM/DD/YYYY format.';
localizedErrMap['custom_date'] = 'Please enter this date in MM/DD/YYYY format.';
localizedErrMap['list'] = 'Please select at least one email list.';
localizedErrMap['generic'] = 'This field is invalid.';
localizedErrMap['shared'] = 'Sorry, we could not complete your sign-up. Please contact us to resolve this.';
localizedErrMap['state_mismatch'] = 'Mismatched State/Province and Country.';
localizedErrMap['state_province'] = 'Select a state/province';
localizedErrMap['selectcountry'] = 'Select a country';
var postURL = 'https://visitor2.constantcontact.com/api/signup';
</script>
<script type="text/javascript" src="https://static.ctctcdn.com/h/contacts-embedded-signup-assets/1.0.2/js/signup-form.js"></script>
<!--End CTCT Sign-Up Form-->