PHP Application Form...

[Winterworks]

These are what I need...

A box for...

First Name:
Box Width=250px, Height=1 line, Allowed Input=25 characters.

Last Name:
Box Width=250px, Height=1 line, Allowed Input=25 characters.

Age:
Box Width=250px, Height=1 line, Allowed Input=2 characters.

Date of Birth:
Box Width=250px, Height=1 line, Allowed Input=8 characters.

Sex:
Box Width=250px, Height=1 line, Drop-down box, with options "Male", "Female".

E-mail:
Box Width=250px, Height=1 line, Allowed Input=100 characters.

MSN: (NOT NEEDED)
Box Width=250px, Height=1 line, Allowed Input=100 characters.

Skype: (NOT NEEDED)
Box Width=250px, Height=1 line, Allowed Input=100 characters.

Daytime Telephone Number:
Box Width=250px, Height=1 line, Allowed Input=14 characters.

Work Experience:
Box Width=250px, Height=10 lines (and scrolls), Allowed Input=1000 characters.

Position Wanted:
Box Width=250px, Height=1 line, Drop-down box, with options "Administrator", "Moderator", "Support Team", "Graphic Designer", "Live Support Representative".

Why We Should Choose You:
Box Width=250px, Height=10 lines (and scrolls), Allowed Input=1000 characters.

Username on Our Support Forum:
Box Width=250px, Height=1 line, Allowed Input=25 characters.

City:
Box Width=250px, Height=1 line, Allowed Input=100 characters.

Can you make this, and make it so when you enter the information, it's sent to mikemersereau@hotmail.com?

Everything is NEEDED, unless beside the name you can read "(NOT NEEDED)".

This is what I need for an application form to become staff on my site. If you don't understand the above... The name above, means the title, the box width is how big it appears, the height is how many lines it is high, and allowed input is how many characters you can enter into the box (characters allowed are, A-Z, 0-9, /, -, ., @, $, and other symbols..)

And I want it so you can submit it, and once you do, it emails it to my email, and in the message, it shows "$title_of_box - $information_user_submitted".

Can anyone do it?