Php form to mysql and imange

Avg Bid (USD)
Project Budget (USD)
$30 - $50

Project Description:
Hi all.

I need a site with as form -+ 11 fields one should be a upload file of a picture, then it should save the data in a mysql database. after that I want to be able to view the details and save it all as a picture that I can send as an email. Budget is very slim.

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