Appointment Booke

I am looking for a an application to run on a BB Playbook / iPad / iPhone. Essentailly I have a booth at a trade show and I am looking to gather information from people and book appointments for them to come into my studio. Name: Appointment Booker. Requirements: Gather informatipon: Name Phone Number Email Address Wedding Date Venue Wedding Website Appointment time What areas they are interested in (Drop box: Photography, Videography, DJ, StoryBook Albums, Spoof Videos, Wedding Website...) This would be defineable on the back end some place. Referal from: (Show, Website, Internet, Personal, Other) Ability to Store the information on my webserver ([login to view URL]) to give me all the above information in a spread sheet. Ability to send out a email based on a template but personalized with names etc and couple of personal lines from us to the clients about their appointment from us. (Connected to internet or send out when inernet connection is available) There will be some modifications and some additional features as well but this is what I have for now. Please check out my website www.yaadain.com. I would like the app to look nice as I will be handing over the ipad or other device to the custome to fill in the information. I can provide you with all the graphics from my website for your design work. Please let me know how much this will cost. Thanks