Client Data Imput Screen

Need member registration data input screen that can be loaded on laptop computers for use at trade shows to capture new member information. Members will input thier registation information Database will include approximately 21 data fields with labels, 6 t to 8 data the fields with drop down options or toggles. All data to be saved in MS access or similar database format or excel. Accumulated data to be imported in to mysql database. Screen must have similar look and feel to actual website member registration page (see link below). All data fields must fit in a single page view. After selecting submit tab the page must reset to blank data input screen ready fo the next customer. <[login to view URL]> ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform Microsoft access, excel or similar data base.