Hi Bernice

I'm not sure how much luck you're going to have asking for someone to write it for you. Perhaps if you go to PHP resources community section you may have a better chance. But maybe you don't even need a database. You don't explain what you need to do with the 'form'. Do you just want someone to email something to you? In which case you don't need a database Or do you want more. Perhaps if you explain what you need more clearly someone can help.