Online Survey Design

I am looking for a designer to help create an online survey.  Specifically, what I am looking to do is survey a group of friends for their input on my wife's 50th birthday travel locations.  Tot do this, they will select a city or activity (e.g. Shopping) from the survey and then I would like 10 or so images to pop up on the screen.  They will then select the image and add some text beside it (i.e. What is their favorite memory of my wife).  The information will be used to select our travel locations and then compile a photo book of both the travel and their thoughts.  Any current survey tool can be used but it has to have the ability to select questions based on user responses, plus allow survey users to select images (photos), and capture text responses.  Not sure if this is even possible but hoping their are some creative designers out there who can help.