custom html/php contest entry form needed

REASON FOR THIS PROJECT SO YOU UNDERSTAND WHAT IT IS FOR: I am promoting/advertising a new, weekly event at a nightclub and I will be doing heavy advertising online. my job is to get people to attend this weekly event by offering occasional contest drawings / prize giveaways at the [login to view URL] enter the contest, they will be instructed to visit my website and i will direct them to a speciual html page for this.? This form will act as a registartion form which they must submit "and" print out and bring to the nightclub. i have? provided specific details for this project. **THIS FORM MUST WORK IN ALL WEB BROWSERS ( INTERT EXPLORER, FIREFOX, SAFARI, ETC)** ## Deliverables REASON FOR THIS PROJECT SO YOU UNDERSTAND WHAT IT IS FOR: I am promoting/advertising a new, weekly event at a nightclub and I will be doing heavy advertising online. my job is to get people to attend this weekly event by offering occasional contest drawings / prize giveaways at the [login to view URL] enter the contest,? people will be instructed to visit my website where the form will be located. This form will act as a registartion form which they must submit "and" print out a generated ticket? and bring to the nightclub. -------------------------------------------------------------- **this is the function needed:** the visitor must fill in these fields: **1:** First name **2:** Last name **3:** Email address **4:** cell phone # ( this field is optional ) **5:** have you ever attended "venue name goes here" ( we need a a "yes" or "no" checkbox for this ) **6:**there should also be a dropdown menu " how did you hear of "our website name goes here"? **A:** word of mouth **B:** browsing the web **C:** attended a venue that "our website name goes here" has appeared at. **D:** regular visitor of "our website name goes here" **E:** saw a "our website name goes here" article / promotion online **F:** print material **G:** myspace bullentin/comment **H:** other once all fields are filled in, when they press the submit button, **2 things MUST happen**: **1:** the info should be sent to a database of some kind for me to collect and store all the the information. ( can be mysql or.. a txt doc.? you make a suggestion on that part. whatever is easier for me to? extract the data from later. I may need the email addresses for bulk emails but i may also have to print a list with all the info? on it? ) **2:** it should then inform the visitor that their info was successfully submitted and then it **also should immediately display a printable ticket advising them to print out and present.**? The ticket should display: **1:** an area to display info about this ticket ( i need to be able to edit this ) **2:** Thier first name **3:** Their last name **4:** a computer generated random 10 digit alpha-numeric serial number ( numbers and letters mixed in a bolder font ).? *****I will? definitely need a way to? adjust/edit infomation ( details ) that will appear on this ticket** ( as mentioned above )? **since i may be reusing this form for different events/contests at a later date. ( So that I can write details about the venue, prize, rules, etc )** I am proficient in dreamweaver so if i can use that program to change details if it is possible in dreamweaver, let me know otherwise, i will need? some way to edit it. can you make the printable ticket inside a dotted line or something so when they print it out, they can cut out the portion that they have to bring with them when they turn it in at the nightclub? my server is unix based and supports php and mysql. my website is mostly html/css but the form will be on its own page so if it must be php, its ok. I am open to database but if you suggest writing the data a txt doc, i can use that also.? you make a suggestion about that. I will be using the email addresses later to contact people about new events and contests so I need the best method of extracting them at a later date for bulk email distribution **THIS FORM MUST WORK IN ALL WEB BROWSERS ( INTERT EXPLORER, FIREFOX, SAFARI, ETC)** I need this? project? done **asap**. I will choose the best qualified coder with good ratings that has the lowest bid.? As you can see, I know exacly what I need . ( see my rating comments ). I am very easy to work with and communicate very quickly if you have any questions. Please only bid if you have ratings on rentacoder and are qualified to do this project. no beginner programmers please. I need someone who knows what they are doing.