67204 Registration script

Looking for a programmer to write a simple registration script for ibill. Example url: [login to view URL] If you click on the join button, you will see a registration form at ibill server. You fill in the form, your data will recoard in ibill server. But I want the registration form to host at my server, after pepole fill in the form, your script will pass the data to ibill server, if everything ok, it will tell the user, store the data in local db and send an email to him. If there is is problem, your script will let the user what's going wrong.