91509 Urgent PHP form code needed

I need the form at the bottom of this page coded in PHP... [login to view URL] If the visitor selects either of the Non-Client Tuition options or either of the Tool Kit Clients Tuition, they need to be directed to this page... [login to view URL] Based on the combination of selections they make they will be redirected to one of 8 URLs which I'll provide. If the visitor selects either of Silver Members' Tuition options OR either of the Gold/Platinum Members' Tuition, they will need to be redirected straight to the URL associated with their choice (again, I'll provide the URLs) and bypass the above [login to view URL] page. Further details can be provided by PM. I need this project completed ASAP. Thanks in advance for your bids.