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<!doctype html>
<html lang="es">
<head>
<!-- Required meta tags -->
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<!-- Bootstrap CSS -->
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css" integrity="sha384-ggOyR0iXCbMQv3Xipma34MD+dH/1fQ784/j6cY/iJTQUOhcWr7x9JvoRxT2MZw1T" crossorigin="anonymous">
<title>Formulario de Incripción | UndervisaMT</title>
</head>
<body>
<div class="row justify-content-center text-white text-center" style="background-color:#020D2B">
<div class="col-md-2">
<img class=".img-fluid. max-width: 100%;" src="https://gallery.mailchimp.com/58cb2a60f3c346759f7fc3582/images/bdb906ee-60ce-4704-bec2-5a494f5cd4a6.png" alt="Undervisa - Bienvenido al 5%" width="222" style="width: 218px; height: auto; display: block;">
</div>
<div class="col-md-12">
<div>
<P>
<em>
Si pudieras decirle <strong>SI</strong> a todo lo que te imaginas ya serias parte del 5%
</em>
</P>
</div>
<div>
<h5><strong>Bienvenido al 5%</strong></h5>
<P>"Recuerda que todo depende de ti, para ver los resultados no esperes a que otra persona los tenga primero, se tu el primero". <strong> <br>Undervisa Master Trading (#UndervisaMT)</strong>
</P>
</div>
</div>
<div class="container">
<H3><strong>Formulario de Incripción</strong></H3>
<link href="//cdn-images.mailchimp.com/embedcode/classic-10_7.css" rel="stylesheet" type="text/css">
<style type="text/css">
#mc_embed_signup {
background: #fff;
clear: left;
font: 14px Helvetica, Arial, sans-serif;
}
/* Add your own Mailchimp form style overrides in your site stylesheet or in this style block.
We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. */
</style>
<div id="">
<!-- Begin Mailchimp Signup Form -->
<form action="https://facebook.us20.list-manage.com/subscribe/post?u=58cb2a60f3c346759f7fc3582&id=5ee273bdb8" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll" class="form-row">
<div class="col-md-12 row" style="padding-top: 10px;">
<div class="col-md-12">
<H5><strong>Datos Basicos</strong></H5>
</div>
<div class="col-md-4 mc-field-group">
<label for="mce-FNAME">Nombres:</label>
<input type="text" name="FNAME" class="form-control" placeholder="Pedro Pablo" id="mce-FNAME" required>
</div>
<div class="col-md-4 mc-field-group">
<label for="mcE-LNAME">Apellidos:</label>
<input type="text" class="form-control" placeholder="Ramirez Lopez" id="mce-LNAME" name="LNAME" required>
</div>
<div class="col-md-4 mc-field-group size1of2 datefield">
<label for="mcE-cumple">Cumpleaños:</label>
<div class="datefield">
<span class="subfield dayfield"><input class="birthday required" type="text" pattern="[0-9]*" value="" placeholder="DD" size="2" maxlength="2" name="CUMPLE[day]" id="mce-CUMPLE-day"></span> /
<span class="subfield monthfield"><input class="birthday required" type="text" pattern="[0-9]*" value="" placeholder="MM" size="2" maxlength="2" name="CUMPLE[month]" id="mce-CUMPLE-month"></span>
<span class="small-meta nowrap">( dd / mm )</span>
</div>
</div>
</div>
<div class="col-md-12 row" style="padding-top: 10px;">
<div class="col-md-6 mc-field-group">
<label for="mcE-EMAIL">Correo Electronico:</label>
<input type="email" class="form-control" name="EMAIL" placeholder="Email@domino.com" id="mce-EMAIL" required>
</div>
<div class="col-md-6 mc-field-group">
<label for="mcE-contacto">Numero de Contacto</label>
<input type="number" class="form-control" placeholder="3010001111" id="mce-PHONE" name="PHONE" required min="3000000001">
</div>
<div class="col-md-6 mc-field-group">
<label for="mcE-pais">Pais</label>
<input type="Text" name="PAIS" class="form-control" placeholder="Colombia" id="mce-pais" required>
</div>
<div class="col-md-6 mc-field-group">
<label for="mcE-Ciudad">Ciudad</label>
<input type="Text" class="form-control" placeholder="Bogotá" name="CIUDAD" id="mce-CIUDAD" required>
</div>
<div class="col-md-12 mc-field-group">
<label for="mcE-invitado">¿Quien te Invito?</label>
<input type="Text" class="form-control" placeholder="Juan Martinez" name="INVITO" id="mce-INVITO" required>
</div>
</div>
</div>
<div class="col-md-12" style="margin-top: 15px;">
<H5><strong>Redes Sociales</strong></H5>
</div>
<div class="col-md-12 row">
<div class="col-md-6 mc-field-group">
<img src="https://gallery.mailchimp.com/58cb2a60f3c346759f7fc3582/images/1e833ed5-651b-4739-ad66-db7ed1710573.png" alt="Whatsapp">
<label for="mcE-whatsapp">Whatsapp</label>
<input type="number" class="form-control" placeholder="573010001111" name="WHATSAPP" class="" value="" id="mce-WHATSAPP" required>
</div>
<div class="col-md-6">
<img src="https://gallery.mailchimp.com/58cb2a60f3c346759f7fc3582/images/489f4e91-a545-41e1-90ba-b36109596495.png">
<label for="mcE-instagram">Intagram</label>
<input type="text" class="form-control" placeholder="@undervisaMT" name="INSTAGRAM" id="mce-INSTAGRAM">
</div>
<div class="col-md-6">
<img src="https://gallery.mailchimp.com/58cb2a60f3c346759f7fc3582/images/a29df822-588b-4d90-92a0-8badc67420c1.png">
<label for="mcE-facebook">Facebook</label>
<input type="text" class="form-control" placeholder="undervisaMT" name="FACEBOOK" id="mce-FACEBOOK">
</div>
<div class="col-md-6">
<img src="https://gallery.mailchimp.com/58cb2a60f3c346759f7fc3582/images/316bcd2b-d83d-435a-b45a-5dc8a10ed702.png" >
<label for="mcE-Twitter">Twitter</label>
<input type="text" class="form-control" placeholder="@undervisaMT" name="TWITTER" id="mce-TWITTER">
</div>
</div>
<br>
<div class="mc-field-group input-group" style="display: contents;">
<ul style="list-style: none;">
<li>
<input type="checkbox" value="1" name="group[387][1]" id="mce-group[387]-387-0" required>
<label for="mce-group[387]-387-0">Acepto
<a href="http://bit.ly/TyCUndervisa" target="_blank">
Termimos y condiciones
</a>
</label>
</li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div class="col-md-12" style="padding-top: 20px position: absolute; left: -5000px;" aria-hidden="true">
<input type="text" name="b_58cb2a60f3c346759f7fc3582_5ee273bdb8" tabindex="-1" value="">
</div>
<div style="display: inline-flex;">
<input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="btn btn-primary">
</div>
</form>
</div>
</div>
</div>
<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[1] = 'FNAME';
ftypes[1] = 'text';
fnames[2] = 'LNAME';
ftypes[2] = 'text';
fnames[5] = 'CUMPLE';
ftypes[5] = 'birthday';
fnames[0] = 'EMAIL';
ftypes[0] = 'email';
fnames[4] = 'PHONE';
ftypes[4] = 'phone';
fnames[3] = 'PAIS';
ftypes[3] = 'text';
fnames[6] = 'CIUDAD';
ftypes[6] = 'text';
fnames[7] = 'INVITO';
ftypes[7] = 'text';
fnames[8] = 'WHATSAPP';
ftypes[8] = 'number';
fnames[9] = 'INSTAGRAM';
ftypes[9] = 'text';
fnames[10] = 'FACEBOOK';
ftypes[10] = 'text';
fnames[11] = 'TWITTER';
ftypes[11] = 'text';
/*
* Translated default messages for the $ validation plugin.
* Locale: ES
*/
$.extend($.validator.messages, {
required: "Este campo es obligatorio.",
remote: "Por favor, rellena este campo.",
email: "Por favor, escribe una dirección de correo válida",
url: "Por favor, escribe una URL válida.",
date: "Por favor, escribe una fecha válida.",
dateISO: "Por favor, escribe una fecha (ISO) válida.",
number: "Por favor, escribe un número entero válido.",
digits: "Por favor, escribe sólo dígitos.",
creditcard: "Por favor, escribe un número de tarjeta válido.",
equalTo: "Por favor, escribe el mismo valor de nuevo.",
accept: "Por favor, escribe un valor con una extensión aceptada.",
maxlength: $.validator.format("Por favor, no escribas más de {0} caracteres."),
minlength: $.validator.format("Por favor, no escribas menos de {0} caracteres."),
rangelength: $.validator.format("Por favor, escribe un valor entre {0} y {1} caracteres."),
range: $.validator.format("Por favor, escribe un valor entre {0} y {1}."),
max: $.validator.format("Por favor, escribe un valor menor o igual a {0}."),
min: $.validator.format("Por favor, escribe un valor mayor o igual a {0}.")
});
}(jQuery));
var $mcj = jQuery.noConflict(true);
</script>
<!--End mc_embed_signup-->
<!-- Optional JavaScript -->
<!-- jQuery first, then Popper.js, then Bootstrap JS -->
<script src="https://code.jquery.com/jquery-3.3.1.slim.min.js" integrity="sha384-q8i/X+965DzO0rT7abK41JStQIAqVgRVzpbzo5smXKp4YfRvH+8abtTE1Pi6jizo" crossorigin="anonymous"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.14.7/umd/popper.min.js" integrity="sha384-UO2eT0CpHqdSJQ6hJty5KVphtPhzWj9WO1clHTMGa3JDZwrnQq4sF86dIHNDz0W1" crossorigin="anonymous"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/js/bootstrap.min.js" integrity="sha384-JjSmVgyd0p3pXB1rRibZUAYoIIy6OrQ6VrjIEaFf/nJGzIxFDsf4x0xIM+B07jRM" crossorigin="anonymous"></script>
</body>
</html>