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Simple User Registration Page (PHP/MySQL)

Hello,

I need a very simple user registration page developed. It needs to simply allow the input of the following fields:

First Name

Last Name

Email Address

Phone Number

Street Address

City

State (drop down list of states listed)

Zip

Drop Down Box with selections that I can modify (e.g., 'option 1 - $49', 'option 2 - $99')

Comments (500 characters max)

And a SAVE button to save the entries.

Validate that the email address is not a duplicate as a check after they enter the value. Similiar to the registration page for freelancer.com.

I would like it to send an email to the registrant (and copy another email address) after they hit save.

And store them in a MySQL database.

My expectations is that this should able to be completed for no more than $50.

To clarify, I expect the page to look and act exactly like the registration section of this page: http://www.freelancer.com/users/signup.php.

If you can not build the page to look and act exactly (except with my fields list above) like the page mentioned above, please do not bid.

Compétences : Javascript, MySQL, PHP

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Concernant l'employeur :
( 10 commentaires ) Granville, United States

N° du projet : #2377631

Décerné à :

amilli21

Hi, please check pm for details. I can have this done within the next few hours if you are still interested.

50 $ USD en 0 jours
(3 Commentaires)
3.2

26 freelance font une offre moyenne de $42 pour ce travail

gslogics123

Respected Sir Ready to start. I have expertise in PHP/Mysql. Please check the message box. Regards Ashwin

50 $ USD en 0 jours
(237 Commentaires)
7.4
neelwt4u

Please check the pmb. With best regards

50 $ USD en 1 jour
(122 Commentaires)
6.9
wsfreelanzer

Hi i'm a PHP Programmer new to freelancing. I can develop your project and will be completed by today itself. So contact me if u r interested. some previous links [url removed, login to view] [url removed, login to view] Thanks, Raj

30 $ USD en 1 jour
(93 Commentaires)
6.8
sam45

can have it done very quickly, please see PM

50 $ USD en 1 jour
(98 Commentaires)
6.4
udanaudayanga

let me do .

40 $ USD en 1 jour
(66 Commentaires)
6.0
majma01

expert web developer is ready to do this job.. See PMB

40 $ USD en 0 jours
(72 Commentaires)
5.9
alok007patel

I can get this completed with in couple of [url removed, login to view]!

40 $ USD en 0 jours
(64 Commentaires)
5.9
exitsol

Ready to get started and can do it real quick

30 $ USD en 0 jours
(108 Commentaires)
5.8
aukint

Lets start it now and get it done in couple of minutes. Please check pm for details thanks.

35 $ USD en 1 jour
(34 Commentaires)
5.2
Butterfly718

Hello,sir. I can help you. Let's start.

30 $ USD en 1 jour
(35 Commentaires)
4.9
whitestardev

Hi. I can help you. Please check pM. thanks.

50 $ USD en 0 jours
(18 Commentaires)
4.9
MakeYouBelieve

Hi, I can do it for you. Regards.

45 $ USD en 1 jour
(39 Commentaires)
4.7
mrintelligence

Look for LIVE DEMO in PMB.

30 $ USD en 1 jour
(9 Commentaires)
4.4
chanUS

Ready to start now.

40 $ USD en 1 jour
(21 Commentaires)
3.7
johnrio

Respected Client Please check my PBM for more details thanks

120 $ USD en 1 jour
(20 Commentaires)
3.7
smakgroup

Ready to start...thanks

40 $ USD en 1 jour
(7 Commentaires)
3.5
muskaan12sharma

I am expertise in PHP. I have completed more then 30 projects in PHP. Please give me the chance to work with you.

50 $ USD en 1 jour
(5 Commentaires)
2.6
Bogdanthd

Ready to this for [url removed, login to view]'s an very easy task .

30 $ USD en 1 jour
(1 Commentaire)
3.2
bdwebtech

Dear Sir I have developed many such project

30 $ USD en 2 jours
(4 Commentaires)
1.8
MTruper

This is a very easy, no-nonsense project. I can have it done for you in a few hours.

30 $ USD en 1 jour
(1 Commentaire)
0.0