basic php/mysql form creation for a sign up page

We need someone to create a form written in php with an html template to collect 4 pieces of information. (It will be a sign up sheet) The info will be stored in a mysql database. The fields that will be collected are: 1)name 2)twitter user name 3)e-mail address (will be entered twice) 4) optional text field We need the fields to support Turkish characters. We also need the php to check to make sure twitter user name(field#2) and e-mail(field#3) do not have duplicates in the database. The email will be entered by the users twice. And the php code should check to confirm they are the same. If the above conditions are not met, user should see the appropriate javascript alert. We don't need you to do any design. You can just provide the basic html template with the 5 fields in a form.