PHP/MySql programming for one page of a template website created in Microsoft Expression Web

In the short term, I have one page of a template which I am customizing (see attached file) on my website that requires access to a mySQL database; my host tech support, the template company\'s tech support and my own research have failed me. I am developing the site using MS Expression Web. I need a programmer to help me make this form operational. In the long term, I would like to find a freelancer to help me when I get stuck, to train me when possible so that I can master repetitive tasks, to provides scripts when needed and other support tasks.