Website Design - Registration Webpage for upcoming Group Buying site

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

Project Description:
I need the design and creation of a simple registration page for an upcoming Group buying site. I will need the below options either, 1 stored in a secure online database, or emailed to me in a format that is easy to copy and paste into a spreadsheet or database, or both potentially.

The fields will be the following:

Email Address*

* Email address will be the only mandatory field

If coming to me in an email I would like it emailed like the below:

Name Email Address Postocde
Example Example Example

Someone with a good design flair and who can also point me in the right direction for the cheap online database storage with no contracts as the email address database will move into the website platform when this is created (another project for this will be listed)


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