Hello,
After reading your project detail I've found that you need to create a form using HTML and CSS with twitter bootstrap. I am interested to create the form for you as there are chances to get more projects.
I'm a Web Designer and working in a Web development firm for 4+ years.I am skilled in creating HTML Template, Converting PSD to HTML, making forms, customize Slider, Javascript, add Contact Form, WordPress websites designing and PHP.
Feel free to contact me for discussion on the project and hope to deliver your project on time and budget.
Thank you,
Makhjan