Build a PH Form that sends traceable emails

I need to create a form in PHP / Wordpress with the following functionality: - Part A of the form: My info. The recipient will fill out the first part of the form with his name, last name, gender, mail, zip code. - Part B of the form: The recipient will fill out the following info for 5 friends: name, last name, email, gender. In total (Part A+B) there are 24 fields. Once submitted, the system must store this info in a database as well as send a traceable email (via mandrill, sendgrid, mailgun, etc) with a unique coupon code. Such code will be taken from a pool of available codes, which may only be used once. In addition, the 5 friends will receive a different message than the recipient, but it’ll be the same email for the 5 of them. As a matter of fact ALL friends will get the same email. Form will be uploaded in a godaddy hosted site. Validations: Email must not be the same y any of email fields Email field must have the basic email validation stuff (no spaces, with 64symbol, etc) Zip code must be 5-digit Gender is either Male/Female. Work must be completed in 72 natural hours upon acceptance.