Simple Webform with PHP

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

Project Description:
See attached forms.
I need a web app that will enter records as seen in the Excel FORM attached to this document.

I prefer PHP and mySQL as I will be hosting locally on my System running XAMPP or WAMP

The Following will be required:

- Web form to Enter Records
- Search page to query records and print out result
- Time Stamp on every record Entered

Field Name Field Type
Date: Calender Selection
Surname Text Field
First Name Text Field
Sex Drop Down Selection (Male/Female)
Age group Drop down selection (Under 18/18-30/30+/40+/50+/60+)
Occupation Text Field
Contact Number (s) Phone Number
Home Address Text Box
Nearest Bus Stop Text Box
Email Email Address
Can we pay you a visit? Drop Down Selection (Yes/No)
If yes, where Address to Visit: Drop Down Selection (Home/Office)
Office Address Text Field
Marital Status Drop Down Selection (Single/Married/Divorced/Widowed)
Born Again? Drop Down Selection (Yes/No)
How did you hear about COZA? Drop Down Selection (Friend/Handbill/Radio/Evangelism/Internet/Others)
Why did you come to Church today? Drop Down Selection (Invited/Live in the Area/Visiting the City of Abuja/Curious About Christianity/Heard about the Church)
Would you like to make COZA your local church Drop Down Selection (Yes/No)
Special Request Check Box Selection (Findout more about COZA/Request prayers for a particular thing/Speak to someone about my Faith)
Comments about Service Text Box

I want search to be perfomed on the following:

Name (First Name and Surname)
Phone Number
Age Group
Can we pay you a visit
Marital Status
Born Again?
How did you hear about COZA
Special Request

The Search Result Summary Page should contain the following fields

First Name
Phone Number
EMail Address
Marital Status
Age Group.

When you click on any of the names in the result page, a popup page should be displayed showing all the information entered about the individual.

The page should also have a password protection system. There will be 3 users
Administator - Can Add, Edit, Remove and Search for records
Manager Can Add, Edit and search
Editor Can Search/View
Phone Number

Skills required:
MySQL, PHP, Software Architecture
Additional Files: First+timers.xls first+timer.txt
About the employer:
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