It needs work. I feel like you half-assed your product image. You should pay someone to make you a better one. That is majorly important. You also need a better headline for it as well as a better submit button and need to shorten the overall height of the opt in box. You want it to display on the very first frame they see. Let me show you an example of how I do it on my blog: http://www.dantheinternetman.com/ The only thing its missing is a small disclaimer that says they will be subscribed to my mailing list. I will add that tonight - kind of forgot about it lol. See how there is a lot of emphasis on the opt in box? You want to pull eyes there so they see it right away. Also, notice the exit pop-up that I installed.
I paid someone to design the cover since I suck at cover designs. I did the rest of the formatting though.
It still need some work. Shorten the text at the top and put in a strong, attention grabbing headline.
If I am looking at it correctly, I dont see a 'name' field in your box, need to know who to address your emails to.