If you are new to coding then you are really diving in head forward, but hey if you get it done you will feel even better. You will have to make the form ofcourse and could then make a CGI script in perl in which you parse the form using CGI.pm for example (for more information about it type perldoc cgi) Then you have to contact the the database to store the information there is another node about it here. If you need more help I suggest you search around a litle because there is alot of information in already given awnsors.
Imagination is more important then knowledge -Einstein-
Originally posted as a Categorized Answer.