Referral Form in node.js with MailChimp support

I need a referral form built in node.js I have already set up the stack, with database (using express and mongodb) and put together a mockup view (see attached file). The form will collect first names, last names, email addresses and phone numbers. A user will be directed to their form with a unique link. The form must display the form user's name. Upon pressing an 'add' button the following four things need to happen: 1) fname, lastname, email, phone number, along with referring user's email need to save to mongo collection 2) new unique form be generated for the name associated with the entered details (which displays their name etc upon load) 3) referred details need to be exported to MailChimp (via their API?) 4) a green tick needs to appear next to added row (which will remain on display, even if user closes & returns to their form) 5) another row of empty fields need to be added to the form, along with a new 'add' button 6) a 'gamification meter' on top right of form needs to increment when a user adds new contact information (needle will tilt up a little each time like a speedometer) *note: all entered data must display on the form when a user return I need this project completed ASAP (within the next 3 - 4 days)