Hi,
If I understand correctly, you need a basic webpage with a form, containing these 7 inputs.
Users will register using this form, entering first/last name, phone number and date of birth.
Email, password and pin will have to be generated from the names. The records shall be stored in a database, and a method must be available to retrieve the contents of the database by the administrator of the web page.
Is this correct ?
Assuming that
* the above is correct
* there is no HTML graphic whatsoever (or, you hire someone else to add it),
* you take care of the installation of the script on your server (or we agree an extra cost for the installation)
I can offer to build such functionality within 3 days for 210 USD.
Regards,
Marek Bukowy