I have a themeforest template that has most of what you need, you will simply need to modify it.
I used this template [login to view URL]
to make a page. (I will show winner)
You need to take the form data from the first page, and transfer via session to next page.
Create a form using same style/layout with 6 additional fields that will tie to [login to view URL] autorepsonder and pre-populated with previous page data.
This should take you less than 1 hour.