Hello. In the log, you can see the two errors. First, for error #2 (the country), you are sending “United States” but Mailchimp does not have that value. The matching value is “United States of America”. You will need to match those in order for the country to be sent to Mailchimp. You can update the value in the form, or in the Mailchimp account so that they match.
For error #1, you are sending “I consent” but Mailchimp is expecting “I consent to receiving emails from WGNV”. Those will need to match in order for you to send this field to Mailchimp.
If you have any other questions, please let us know.