Wordpress Site Add Form and Features #2

If you copy and paste me a message I will report you. I need a form created on my site with the following stuff with it: • Entry form must remain link off of terms and conditions page • Entry from add simple capatcha • Form validation • Email to me on contest entry plus entry into contest db • Enable cookies to remember personal info details • Which advertiser might you do business with” to be drop down list of active advertisers this should pull information from the DB This needs to be fully responsive. Which should not be hard since my site is already responsive. Maximum Budget is $30.00 USD