CONTEST FORM

I need the ability to have visitors to [login to view URL] to place a 6-digit number, Birth date and their email address into a text box located on the front page. Once this info is applied and the customer press enter I want them to be directed to a second page that will let them know that an email was sent to their email account letting them know if there are winners. The customer will then receive a text email. I want the winning 6 digits (which will be several that i will be able to change when needed) to get a separate email letting them know their won. The data that the contestant place in the text box must then be sent to my email address with the subject of the email being “contest”.