beta-user registration script - on Wordpress

Webpage form design and sign up script. The object of the page is for people to pre-register for a beta program. The landing page will be a wordpress blog page so you need to be able to work with wordpress to get this script running. The person seeing that page will have a form to fill out. The fields will be - Company: Name: Country: Email: Captcha or equivalent spam protector: **Submit button** * They should receive an email back with a Thanks for signing up message * The collected information should stored in a db that can be exported to excel easily for a non coder (me) * If the email is already submitted they should receive a "you have already signed up, Thanks!" message on the site. You will be given root access to the server and need to install the page and test it to make sure it is running correctly in Ffox, IE, Safari, Opera - and make sure that the graphics and formatting are correct and not corrupted. A good example is something like this - but with a few more fields. [login to view URL]