312453 CC Form + Event Registration

Single form to register for a yearly conference and process credit card transactions for conference and/or member fees. Dates/Prices should be able to changed from a simple back end interface. Major Points • Fill out the form and pay/process online (through PayPal Payments Pro) OR Fill out the form and mail in payment (send invoice to email for it to be printed as a PDF attachment). • Need a single form to process credit card transactions via API with [login to view URL] (PayPal Payment Pro) - MySQL Database backend. • Backend to adjust dates/deadlines/pricing based on member/non-member & dates. • Backend view only of logged transactions with all information recorded in the database including transaction time. Backend view will be able to select date ranges to sort information. • Backend administration user management, username, password, email. Send email to username on file for password reset for backend login. • Email confirmation of receipt to end user and notify administrator another registration. • Integrate reCaptcha ([login to view URL]) image verification (prevent spam submissions). • Form does not close after event date. • Make it a single PHP include to integrate to our website or all the code contained in a single DIV element. • Must use HTTPS/SSL Form includes: • First Name • Last Name • Title/Department • Nickname for Badge • Institution/Company Name • Mailing Address • Mailing City • Mailing State • Mailing Zip • Check Box and auto-populate if the same for billing address • Billing Address • Billing City • Billing State • Billing Zip • Country • Telephone Number • Fax Number • Email Address • Vegetarian (Boolean) • Food Allergies • First Conference (Boolean) • Year Experience in field • Credit Card Number • Credit Card Expiration Date • Credit Card Type • Name on Credit Card • Credit Card CVV There are two forms in the PDF file to see how registration takes place within our organization but on paper.