PHP Registration Page

Avg Bid (USD)
Project Budget (USD)
$30 - $250

Project Description:
This is a very basic project that I need.

I need someone to create a php registration page which takes users information: First Name, Last Name, Email address, Age, ReCaptcha and dump this information into a database ( I already have the database and tables(firstname, lastname, email address). Once registration is completed then customer is "Thanked" and redirected to a URL

I'm more interested in the registration page lookiing well designed, and secure. Aesthetics is very important (No images).

Skills required:
Customer Support
About the employer:
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