Change a Webpage (Squeeze Page)

The current squeeze page has an Aweber (email client) box and only allows access to those who offer their email. I would like to change this to a split screen with the option of 1) accessing the home page after opting in the email box OR 2) accessing the home page directly, without opting in the email box I have added a screenshot of what I would like this to look like, but I will change the words and send you a photo for this page. I am just asking you to create the same page as the attachment, but with my text and photo. And the Aweber email box should be used to capture the emails. I will send the code, but I would like the graphics to look like the attached screenshot. In other words, the email box will not look like the standard Aweber email opt-in box.