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I need a PHP programmer to complete a simple php form for registration

This project received 64 bids from talented freelancers with an average bid price of $55 USD.

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Project Budget
$30 - $250 USD
Total Bids
64
Project Description

Registration form contain

Full Name, Blood Group, Gender,Date Of Birth,Mobile Number,Land Line Number,Select State,Select District,Select City,E-Mail ID,Permanent Address,UserId,,Password and an email link activation .

The project must be done within 4 hrs.

ITS VERY URRGEENT TO COMPLETE within 4 hrs.

HTML Template is already done. only need to write php code.

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