opt-in form issues

Hi,

The opt-in form that I have created on a sales template is not working and I am wondering what else I can do. The autoresponder code is definitely correct and shows entirely in the opt-in code options box, however, the list name value is not showing on the web page:

http://sophiasoul.com/yourowninternetbusines/six-figure-mentors/

The ‘Hidden Fields’box also keeps coming up as ‘undefined’.

Any suggestions would be greatly appreciated

Sophia