We need a freelancer to make a web form (in PHP with MySQL) out of a paper form.
The paper version of the form is the attachment (the two last pages of the document). The final web form should have a similar disposition to the actuel form. We'll provide you the requiered fields. A validation should also be done on selected fields (phone number, webmail, etc.). There will also have some minor modifications to do (eg. add a "I understand that blab blah blah" cheekbox and a 200 words textfield).
We also are looking for an administration panel (with a password) where admins will be able to delete or modify entries. We will be able to show you exactly what we are looking for.
If you bid on this project, please have some realisations to show. You'll also need to be able to complete the job before or on saturday... You can use any PHP tools you want.
We are looking for someone who will be able to do a minimalist but good-looking CSS job. We will pay a bonus for a fast & clean job.