Classic ASP - Create a registration form

I am looking to have a registration form created. My site is written in Classic ASP. The form will have the following requirements: 1.) Collect information based on the attached screenshot 2.) Post the results of the form collection to an Access database (you create the database table) 3.) Have a read only confirmation page after submitted similar to attachment There is a calculation done on the form based on a default value and then as each checkbox is checked, the total is changed. The user submitting the form can submit the form and then resubmit/update the form at a later date.