build a registration interface for php site and build MySql Database

I need to build a registration form for a website.? The registration form shall bear the following fields and a mysql database is to be? created? : ------------------------------------------ Owners Name:? Mandatory Owners Address: Mandatory Owners Province:? Mandatory Owners Primary Phone Number:? Mandatory Owners Emergency Contact Number: Mandatory Owners Email Address:? Secondary Contact Person Secondary NumberMultiple Registration:? ? ? (1-2)? ? ? ? ? (3-10)? ? ? ? (11-25)? ? ? ? (26+)? (this is where people can click on if they have one or more horses, tack or animal.? Hopefully we can have it so that if they hit on more then one the only thing they would have to change is the animal information and the pay pal would calculate the total price) Name of Horse/Pet or Misc.? Barn Name Horses Breed Is the Horse Registered with an Association please specify Gender:? mandatory Age:? mandatory Weight Height:? mandatory Identifying Markers Brands, Tattoos, Scars, etc....? ? ? Current Market Value of Horse Is horse/tack insured? Name of Insurance Company: Upload Identification picture (horse/tack/misc.) Upload Coggins Test Upload DNA Test Upload Registration Paper ? Potential Disciplines or Skills Make of Tack: Please Provide Description: Enter Micro Chip Number: Enter Unlock Code If registered with another recovery system please identifyEnter Micro chip Number Any other comments to add.