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creating web form for a newsletter (Simple Project)

I have mailing software from Omnistaret, I need to add a simple webform for user to sign up, it is ready and can be gennerated automaticlly, but the problem that i need it to be in Arabic, and everytime i put it gave me an error

so i need some one to fix the problem

here is the example

[url removed, login to view]

the second field is "Age"

the hosting company is hostgator

Compétences : Conception graphique , HTML, MySQL, PHP, Design de site internet

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Concernant l'employeur :
( 18 commentaires ) London, Egypt

N° du projet : #1629638

Décerné à :

spotlayer

hello egycorner We Have Gone through your requirement and understood, we are very sure that we can do your needs with your entire satisfaction. We have left a PMB for you plz feel free to have a look over there.

30 $ USD en 0 jours
(5 Commentaires)
3.6

17 freelance ont fait une offre moyenne de 57 $ pour ce travail

becomeexpert

Let me do it right now. Waiting for your selection to proceed on. Thanks.

30 $ USD en 1 jour
(192 Commentaires)
7.7
seekdeveloper

Hi, Kindly check PMB

250 $ USD en 1 jour
(72 Commentaires)
7.5
gopalvora

ready to start Thanks

30 $ USD en 1 jour
(276 Commentaires)
7.4
ExcellenceonPHP

LETS DO IT RIGHT [url removed, login to view]

35 $ USD en 0 jours
(210 Commentaires)
6.9
expertonphp

Hello Sir, We have understood your requirements and can do this job very easily. We have 5+ years of experience in Web Development. We assure you that we will provide you quality work at reasonable prices. Thanks!

30 $ USD en 1 jour
(106 Commentaires)
6.3
MinaAlfy

Please check your PM

30 $ USD en 1 jour
(43 Commentaires)
5.4
tooltor

Expert developer here, please read the private message.

30 $ USD en 1 jour
(45 Commentaires)
5.3
webedict

HELLO SIR, READY TO START. LETS START AND FINISH IT ASAP. I HAVE 3 YEARS OF EXPERIENCE IN PHP, MYSQL, AJAX, JAVASCRIPT, XHTML. THANKS !!

30 $ USD en 0 jours
(63 Commentaires)
5.2
jasoncar

This seems pretty straightforward. Please see message attached.

30 $ USD en 2 jours
(3 Commentaires)
5.3
MakeYouBelieve

Hi, I can do it for you. Regards.

30 $ USD en 0 jours
(48 Commentaires)
4.8
zakir375

We have a team of Web Developers with over 5 years experience, please see PMB for more details.

30 $ USD en 2 jours
(8 Commentaires)
4.5
SourcerersInc

I have an easy solution for your problem if contacted I can take care it for less than a day.

30 $ USD en 1 jour
(0 Commentaires)
0.0
rohittank

Hello i can do this very easily and also i have done many project like this

30 $ USD en 0 jours
(0 Commentaires)
0.0
J5W7B9jRf

<b><i>Removed by Admin</i></b> - Custom software development - skpye: <b><i>Removed by Admin</i></b>

250 $ USD en 1 jour
(0 Commentaires)
0.0
iamvasim

skype : vasim_padhiyar

40 $ USD en 1 jour
(0 Commentaires)
0.0
samtechs

Ready to work with you please check PMB

30 $ USD en 1 jour
(0 Commentaires)
0.0