How to fix my PHP Script

1) Project Details: PHP Script not working

Good Afternoon,
I own a small Barbie Doll company ( http://www.dollgenie.com ) which is starting a VIP Membership Club.

This club will feature discounts, free shipping and contests for members only.

Although I have designed and implimented my entire web site, I don't have a clue how to do PHP Scripts

I do have an SQL account with GoDaddy

I made an attempt at using a free online PHP Script to create a registration form.. but... its just not working ... and... I am too frustrated and not techno savvy enough to continue or fix the problem.

here is a link to the page I have been working on http://www.dollgenie.com/club/register.html

I would like to maintain the "look" of this page.. but ... I need the expertise/services of someone who can properly code all of this for me.

If you are interested, please contact me maczik@dollgenie.com

~ ~ ~ ~ Mission accomplished!!!!