Convert HTML form to view with native controls on iPhone (Obj C)

This task i fairly simple. We have a form in HTML that we want to convert to be used in our iPhone (Obj C) application. Basically we want a UIView-derived class or similar to display and get info from the form which should use native iPhone controls. The HTML form we want to convert is this: [login to view URL] The result should be something along the lines of the attached screenshot, using similar controls. We leave up to the designer/programmer to come up with an interface and use of controls that suits the task, is easy to use, is not cluttered and, of course, beautiful. For setting the dates (as shown in the HTML form) one might decide to use UIPickerView, but be sure to put it on a separate page (like the selectbox example in the screenshot) so the main form doesn't get too cluttered and complex for the user. Select boxes can be made similar to what is found on the iPhone under Settings -> Brightness -> Auto-Dim. We also might need some assistant with getting it to work with the rest of our application, but if built correctly we will figure it out ourselves.