Need a simple CSS form creating with PHP validation

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I need a form creating for my website that will ask user for his/her details, and address etc.

I have a example of a form which I would like a replica of styling wise.

All validation should be done via PHP not javascript, so checking fields are not empty and only contain the type of values they should do.

1 input of the form should be controlled by a slider, so you must be competent to do that.

Skills Required

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