Request "add Me To Your Newsletter" Widget

Hi,

I am looking to make a "Add me to your Newsletter" sidebar box (i'm using widget framework). I need this widget to:

• make email lists that i can use for Mailchimp campaigns
• to be active for guests and members as well

In fact, the site is about recomandations and i want to make a "recommendation of the day" newsletter.

If you can help me, please let me know somme details (price, duration, etc.)

my website is (i can not attach it)
Thank you!

P.S.: It doesn't have to be a widget, it can be a custom template to, if i can change and manage it.