I want a php script written which generate a form will capture the following visitor information: First Name,Middle Name,Last Name,Current Name,Gender,Birthdate,e-mail. This information is then to be e-mailed to a configurable e-mail address. A button at the bottom of the form will active a checking process to ensure all data is entered correctly. I will supply some code and some screenshots showing the look and feel of the form.
This should not take long for a seasoned PHP programmer.