Problem with Email Opt-In Module in Divi Builder

I haven't been able to get support from ET directly on this so I'm hoping I may be able to get some help here. At http://maryeclark.com/now-its-marys-turn/ I'm running the Divi Builder plugin on a "blank" theme page template that's meant for stand alone landing pages. The email opt-in module is not responding properly. When you click the form fields the placeholder text is not clearing, and when you press the submit button it's not doing anything. I've tried it in a few browsers and cleared all caches. I have a second site that's running on all the same security and cacheing plugins etc, but it's using full Divi. That email opt-in is working fine.