Create a form and integrate with my co-registration program

This is some what simple task. Below is a screen shot of what kind of form I will need and it will need to be integrated to my co-registration program. The JavaScript code will be send to the employee. The fields on the form will not be the exact same. It will actually be less.

Want the exact replica. Not animated. Looking to get it done in the next 2-3 hours

Kemahiran: HTML, Javascript, MySQL

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Tentang Majikan:
( 7 ulasan ) Carteret, United States

ID Projek: #4118935

Dianugerahkan kepada:


****.. 12 YEARS of EXPERIENCE .. **** Hi. Ready to start; I can start right away. Thanks.

$40 USD dalam 0 hari
(76 Ulasan)

5 pekerja bebas membida secara purata $72 untuk pekerjaan ini


Hello, I can start right away. Please check your inbox for some questions I sent. Thanks.

$120 USD dalam sehari
(21 Ulasan)

ready to start and finish next 2 hours for you

$40 USD dalam 0 hari
(21 Ulasan)

We can get to work right now on this. I am online for a few hours now and shouldn't take too long at all. I have extensive JavaScript, PHP, HTML, CSS and many more language skills and you can view my portfolio for more Lagi

$100 USD dalam 0 hari
(3 Ulasan)

Dear Hiring Manager, I am a good PHP programmer and Designer, having experience of developing so many web applications in PHP, HTML5 and CSS3 with MVC joomla and wordpress.I know OOP with MVC architecture and yii f Lagi

$60 USD dalam sehari
(0 Ulasan)