Create a Copy of This Page with my Form Code

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

Project Description:
I need a copy of this page:

Now here are the more "Detailed" details...
I'm looking for someone that can create a clone of this page that I can then go in and create different versions of as needed, such as:
- The title
- The time within the title text
- The body text
- The form code

I need to be able to "EASILY" change these elements to create 50+ different versions of the page one at a time, when needed.

Take a look at this video to get a clearer understanding of what I need.

This seems like an easy project, but please pay attention to everything that I've written out for you here and given you in the video to be sure you understand 100% what I need.
When bidding please state
#1- How long it will take for you to do this
#2- Exactly what you will do

Skills required:
Graphic Design, HTML, PHP, Website Design
About the employer:
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