Convert 2 cgiemail forms to either perl or php

I have two pages that have cgiemail forms that were created around 15 years ago. My website is moving to another host which does not support the cgiemail, thus they need to be converted to php or perl (whichever makes the most sense, while still maintaining an email message that is identical to the one cgie is generating now. Included here is one of the current html forms as well as the formmail file used to generate the email. The catch here is that I am in a pinch for time and need this completed within the next few days.