PHP/MySQL form

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

Project Description:
Create a PHP/MySQL form and associated data table for the attached screenshot. Edit, delete, add should all be done from the same page, not multiple pages or includes, with the exception of a required object class for database calls. Additional inline functions are welcome within the page code. Field names will be provided for every field on the form.

Skills required:
CSS, HTML, Javascript, MySQL, PHP
Additional Files: 20110310_dentalEvaluationForm.png
About the employer:
Public Clarification Board
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