Facebook Fan Page Contest

I need a facebook fan page as the picture with Flash or php and i need to save data of the user( name, city, ID number (RUT),email, Selected room, and GIFT). The fan page is for a small hotel in Chile so user put his information, and then select a room of the hotel, and a gift to win. Is for make a contest to win a night in the hotel. 6 STEPS: 1)Users has to press "I like button" to see the APP 2) Now users see the video of the hotel, with a button of PARTICIPATE 3)When they press Participate, they have to put the name, email, ID number. then press continue. 4)Now they select one of 3 rooms available that they want to win, and a Gift to get with the room. In the same page, user has to give the reason why they think that he has to win the contest. 5) Finish page where saids Congratulations, now you are in the contest, with a button of finish to go to the wall of the fan page. 6) At the end, you share on your wall that you are joined in the contest. The data has to be saved someway. (Name, email, id number, room selected and gift)