Online Competition data capture

Not a big job. I want 3 or 4 web pages designing that we are able to change on a monthly basis depending on the competition we have. We want to capture the data, and either get the data to be collected in a database, or in a new list in Vertical Response. We are then able to see how many people have entered the competition and email directly to them. By segmenting the entrants into different lists, we can follow the return on investment in the future. The competition page will show an image at the top, then some text, then the test boxes that will capture the data. This includes: Name Address County Post Code Telephone Number Date of Birth Plus a little more information The entrant will then need to enter a Spambot question to ensure they are genuine. Then click submit. On clicking submit, the entrant will be taken to a new page, and then be able to enter email addresses and names of friends. On clicking enter, the emails will then be sent to the friends with a link to the competition page. As the user clicks next, they will be taken to Twitter and Facebook share page, the logos will be displayed and they can then post to Facebook or Twitter. We will design the images for the page, the 'click to enter' buttons etc. It is important that you are able to either work with vertical response in order to complete this, if not, we need a very simple way of extracing all the details in a csv so we can then import into vertical response. Please only enter if you can complete this within 7 days. Please only reply with sensible bids. If you bid and you are not able to complete in the timescale, we will leave negative feedback. Please only reply to the job with written replies, not pre-typed replies that you send to all jobs. Please PM me any questions you have on this project and we can answer any questions you may have. Thanks