Could I just confirm that you want a single page designed and developed to outline a promotion you're offering? I understand that it needs to take in a user's name, email and what sort of information?
Would you also require the page to be adaptable, so that you can edit the contents for future promotions?
And finally, what language would you require it to be coded in, ASP or PHP? (just to make sure it's all good with your web hosting company).