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JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
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I'm sorry for the trouble caused to you. Here are the steps I would suggest:
#1. Please remove the phone field from your form and add a normal textbox to collect phone number?
#2. It seems in mailchimp list you have one full name field which was mapped with "Friend's Name" field of your form. But you seems to have two separate fields in mailchimp list "Your First Name:" & "Your Last Name:" which cannot me mapped with full name field of your form. Please remove the second full name field of your form and two different text box. Please check the screenshot below:
The above two changes should actually fix the problem you are having.
Do test it out and get back to us if the issue persists.