Add a form to an existing site

for www.faithlegalservices.com. Generally, the web pages for our site are done, but we would like an online application added as a fillable form, which would then email the information to our Membership Coordinator when the “SUBMIT” button is clicked. I’ve designed a mock-up of the form using Dreamweaver, which is attached. Here's what we had in mind. A link to the application page added to one of our existing pages ([login to view URL]) The form having the background coding (ASP/CGI/JavaScript, etc.) added so that the form data can be emailed. A reply page that would acknowledge that the information has been received and sent. Our webhost provider is Network Solutions, and we have a UNIX hosting account with them.