Web Form (HTML) that sends email via PHP (must complete today)

I have a very basic web form: http://digitaldiploma.knowcrunch.com/ (click BOOK NOW to see the form) which is simple PHP and HTML (and maybe JS and CSS connected to the form). No CMS.

I need to add the following fields to my form (HTML and PHP):

Name: (required)
Last name: (required)
Email: (required)
Mobile phone: (required)
Address: (Street) (optional)
(Number, P.O. box, City) (optional)

(radio buttons)
Ticket type: (Early Bird/Normal, Unemployed, Student, Group, ACG Alumni) (required)

(radio buttons)
I want to pay: (Card, Bank Transfer, Cash) (required)

Check box (I need an invoice)

Check box (by clicking this I accept the terms)

BUTTON (Book Now)
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When clicking form sends an EMAIL with all data and the page redirects to a THANK YOU PAGE (which is ready).

I need to:

- Customize the PHP file associated with all these fields.
- Customize the HTML form with all these fields.
- Make sure CSS & JS are also in-line
- Make sure form is secure
- Make sure submit button does not submit twice.
- Make sure the form accepts and sends by email all different alphabet characters (UTF8)