Daily UI #001 - Sign Up Screen

Here's my first shot for the Daily UI Challenge! Although I won't be doing it daily (work and other commitments), I will be doing it as often as I can and posting the results here!

Wanted to push myself out of my comfort zone and start creating a better portfolio. This is a sign up screen for a social network called Circles - a social network for only your closest circle of friends. Please let me know if you have any thoughts on how to improve the design!