<div class="widget_wysija_cont widget_wysija">
    <div class="wysija-paragraph">
        [email* your-email class:form-control class:wysija-input placeholder "Email Address"]
    </div>
    [submit class:btn class:btn-default class:wysija-submit "Go!"]
    <div class="wysija-paragraph">
        <label class="checkbox checkbox-inline"><input type="checkbox" class="wysija-checkbox porto-disable-modal-onload" name="wysija_donot_popup" value="1">Don't show this popup again</label>
    </div>
</div>