110436 Video Upload

I require a simple website that allows someone to enter their name, address, phone, numbers, city, state, Zip and put them into a MYSQL database. They also need to be able to upload a 10 minute video similiar to YOUTUBE (see YOUTUBE formate for uploading videos. Each video must be able to be selected based on the persons name in a list and played with sound. The list must be able to be sorted. This is phase one of a project.