JavaScript form to output html - Urgent

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Unique S.Jagdish R.Tee Li T.Hasnain R. + 1 other have already sent a proposal.
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Experience Level: Intermediate
I need a JavaScript coder to create a simple form that will allow the user to input info info and then output the html document.

Basically I need to create a playlist file (of male and female swf files) therefore user should be able to add the file name and extension (all files will be in the same folder - if the script can upload to that folder it would be great but this is not a requirement). The user should be able to specify how many items they are going to enter in each section or be able to click a button to add extra entries which can be done using JQuery .live( eventType, handler ) something similar to this

Please see attached file for the html code I am trying to achive: Let me know if you have any questions

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