dynamic JavaScript form for my Join now page

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

Project Description:
i need a dynamic JavaScript form to join members up to my sites from one place.

i have got 5 sites for different countries all similar to each other like so..


i have form completed and working but need one more field that is 'country'.

'country' will determine where the form will be sent to join up.

i need to test it to see if it works before i release the funds. i can give you more details once you bid.

Skills required:
HTML, Javascript
Hire dalesully
Project posted by:
dalesully United Kingdom
Public Clarification Board
Bids are hidden by the project creator. Log in as the employer to view bids or to bid on this project.
You will not be able to bid on this project if you are not qualified in one of the job categories. To see your qualifications click here.

$ 64
in 2 days
$ 257
in 15 days
$ 103
in 3 days
$ 100
in 3 days
$ 34
in 1 days
$ 55
in 1 days
$ 35
in 0 days
$ 40
in 3 days
$ 33
in 0 days
$ 55
in 1 days