Add a Form to a Mobile App

We want to add a simple form to the Mobile App. This forms needs to be enabled for only a limited amount of time. The form data needs to be stored in a MYSQLas to be table. the form should disallow same users from registering multiple times. The Form needs to have the following information in it FORM PAGE ---------------- Note: This Form is only available for folks residing in Hyderabad,India Description: This form is open for momineen in the city of Hyderabad,India. We need your help in getting this information so that we can send notifications via SMS as well as maintain a database of momineen in Hyderabad which we can use to keep the community updated of events in the future. This Form will be open till 16th RabilAwal. All the entries that would be received till 16th RabilAwal will enter into a draw and one person’s entry would be picked by our Random Picker Software. MyAzadari would give this person an opportunity to fly to Iraq for Ziarat in Aashura 2016 and this opportunity would be via a Mumbai based Tour Group. The person whose random entry was picked would be announced on the Android App in the Announcements page as well as on our Facebook Page on 17th RabilAwal You can also send in entries via the website([login to view URL]) *Terms and Conditions apply Name(Mandatory) Email(Mandatory) Phone Number(Mandatory) Mode of Communication(Mandatory)-Email,SMS,Whataspp,Android App(Select any 2) (if Whatsapp or SMS) pop-up a tooltip which says that Majlis Information would only be sent from Next Year onwards Address(Mandatory) pop-up a tooltip which says that this is needed incase your entry is picked by us Announcement interested in (optional)-Retrieve Announcement Category from MYSQL DB table Anjuman for which you need notifications(Mandatory)-Need to give a list of anjumans as stored in the anjuman table in the MYSQL db Improvements we can make to this app(Optional) Majlis Information you would like to Publish(Optional)-Throw a ToolTip (Please enter in this format Arabic Date,Place,Time,Qibla/Speaker,Anjuman,Gender) <Submit Button> This is an urgent piece that we need to incorporate within the app. We also need a walkthrough of the changes that would be made to the app