php programmer needed

1. One of my customers wants to make a contest page in php, that collects maybe 4 or 5 fields like

1. full name
2. valid email address
3. gender
4. question with 4 or 5 options
5. question with 4 or 5 options

puts that info in a database when they click on submit, then they are taken to a thank you page. ie. forwarded to a thank you page.

Can anyone get this done for $25 to $50.

contact me on AOL IM: soulconscious