Rewards card registration

We are are issuing a loyalty program to our customers and need a method to register cards and use the registration information for a newsletter. To do this we will need a link on our existing web site ([login to view URL]) where users can register their newly acquired loyalty card. The registration solution will need to record the card holders first and last names (both required), company (required) email address (required), age (required) and phone number (optional). There will be a tick box that when checked indicates that they have read our terms and conditions and a save button that records this information to a table. There will be a link beside the check box that transfers them to our terms and conditions page and on this page is a return link back to the original page. We will need a way to be able to download the table contents in csv file.