PHP Form

Hello, I need a php form designed with the following fields and features. FIELDS First Name Last Name Email Address (Verify using ajax) Mailing Address City State Zip How likely are you to purchase season tickets if the Sonics relocate to Oklahoma city (Radio Button) Very Likely, Likely, Not Likely When you attend events in Bricktown how likely are you to dine at a Bricktown Restuarant? (Radio Button) Very Likely, Likely, Not Likely Click any Bricktown restaurants below you have previously dined at (check boxes) I will supply list of restaurants. Once a user submits the form they need to be directed to a confirmation page. The form system needs to send out a confirmation email that contains a confirmation link they must click on that when clicked takes them to a confirmation registration page that generates a unique "Fan Number. The user data needs to be stored in mysql and accesed via an administration panel. Along with the user data submitted on the form it should also capture their IP and time of registration. You may either write the code from scratch or use an existing system and adapt it to our needs. ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform Linux, mysql, php