Emergency Alerts

<form class="" action="#" method="post">
    <div class="fs">
        <div class="fs-c m-b300">
            <div class="txt">
                <label for="email" class="txt-l txt-l--mt000">Your email address</label>
                <input id="email" type="text" value="" placeholder="email@address.com" class="txt-f">
            </div>
            <div class="txt">
                <label for="phone_number" class="txt-l txt-l--w txt-l--mt000">Your phone number</label>
                <input id="phone_number" type="text" value="" placeholder="Phone number" class="txt-f">
            </div>
        </div>
        <div class="fs-c fs-c--i">
            <label class="cb">
                <input id="checkbox-call" name="checkbox-call" type="checkbox" value="public_notices" class="cb-f">
                <span class="cb-l cb-l--sans">Call me</span>
            </label>
            <label class="cb">
                <input id="checkbox-text" name="checkbox-text" type="checkbox" value="public_notices" class="cb-f">
                <span class="cb-l cb-l--sans">Text me</span>
            </label>
        </div>
        <hr class="hr hr--sq" />
        <div class="fs-c fs-c--i m-b300">
            <div class="txt g--6">
                <label for="first_name" class="txt-l txt-l--mt000">First name</label>
                <input id="first_name" type="text" value="" placeholder="First name" class="txt-f">
            </div>
            <div class="txt g--6">
                <label for="last_name" class="txt-l txt-l--mt000">Last name</label>
                <input id="last_name" type="text" value="" placeholder="Last name" class="txt-f">
            </div>
        </div>
        <div class="fs-c m-b300">
            <div class="txt">
                <label for="zip_code" class="txt-l txt-l--w txt-l--mt000">Your phone number</label>
                <input id="zip_code" type="text" value="" placeholder="Zip code" class="txt-f" size="10">
            </div>
        </div>
        <div class="fs-c m-b300">
            <div class="sel">
                <label for="language" class="sel-l sel-l--mt000">Choose a language</label>
                <div class="sel-c sel-c--fw">
                    <select name="language" id="language" class="sel-f">
                        <option value="en">English</option>
                        <option value="es">Spanish</option>
                        <option value="cn">Chinese</option>
                    </select>
                </div>
            </div>
        </div>
        <div class="fs-c fs-c--i fs-c--c">
            <label class="cb">
                <input id="checkbox-call" name="checkbox-call" type="checkbox" value="public_notices" class="cb-f">
                <span class="cb-l cb-l--sans">TDD/TDY Device - Tone Delivery</span>
            </label>
            <div class="m-lAAA m-t300 m-t300--mo">
                <button type="submit" class="btn btn--700">Sign Up</button>
            </div>
        </div>
    </div>
</form>