Hello there ,
I read you project description carefully .. and I have the required skills for it .As I have been working as a web developer using PHP&MYSQL and related technologies for the last 10 years .
And I can add your form fields easy God willing .
Be sure that I will do my best to make you more than satisfied with my work , As I do care for my clients so much , because I'm interested in building a good reputation here on freelancer :)
So if you are looking for a fast and professional service , please contact me .
Thank you and waiting for your reply .