<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<div class="container">
<div class="row">
<div class="col-md-4 col-md-offset-4 col-sm-6 col-sm-offset-3 col-xs-8 col-xs-offset-2">
<div class="panel panel-success">
<div class="panel-heading">
<h3 class="panel-title">
<span class="glyphicon glyphicon-envelope"></span>· Newsletter Signup
</h3>
</div>
<div class="panel-body">
<div class="media">
<div class="media-body">
<h4 class="media-heading text-success">
Pellentesque sed arcu lacinia
</h4>
<p class="margin-top-10 margin-bottom-20">
Aliquam sem velit, rhoncus sed arcu eu viverra. Suspendisse lacus posuere ultricies turpis.
</p>
<form>
<div class="form-group">
<label for="newsletter-name" class="hidden">Name</label>
<input type="name" class="form-control" id="newsletter-name" placeholder="Name">
</div>
<div class="form-group">
<label for="newsletter-email" class="hidden">Email address</label>
<input type="email" class="form-control" id="newsletter-email" placeholder="Email">
</div>
<button type="submit" class="btn btn-default btn-block btn-success">Submit</button>
</form>
