Fancy / Pretty PHP Contact Form

Hello

I would like a fancy/pretty PHP contact form with ajax validation. Fields as follows:

How did you hear about us? [text field] (watermarked Google)
Occasion [text field] (watermarked Wedding)
Event Date [text field / text field / text field] (watermarked DD / MM / YY)
Start Time [text field : text field : text field] (watermarked 7 : 15 : pm)
Finish Time [text field : text field : text field] (watermarked 12 : 00 : am)
Venue Name [text field] (watermarked Wick Farm)
Venue Location [text field] (watermarked Bath)
Is access via stairs? [Yes/No radio]
Title [text field]
First Name [text field]
Last Name [text field]
Email Address [text field]
Daytime Telephone [text field]
Evening Telephone [text field]
Prefered Contact Method [Telephone/Email radio]
Additional Information [textarea]

All fields except Additional Information are required.

The submitted form should be emailed to me.