Develop wordpress Landing Page

Develop a word press based landing page that will allow a visitor to submit their email address, a short text description about themselves and receive a unique shortened URL they can cut and paste to refer others to sign up. After entering an email address, they are presented with a unique shortened URL that they can then cut and paste to their friends and get them to sign up. The system will track for each entry: - email entered, unique URL, referral URL (if any) - some type of simple dashboard to view and edit these entries It should work like [login to view URL] - but using wordpress so we can add news and info below, like [login to view URL] I have images to include in the landing page. UI design experience preferred.