PHP Contact form

I need a PHP contact form coded with (*Name, *Email, *Address, *City, *State, *Zip, Country, Phone & a Comments field). Only the fields with the asterisk* are the reiqrued fields.I would like the State and Country to be dropdown selections. I would like the fields to have regular expressions to protect from SQL injections, along with all of the fields to store the information after the user try's to submit but didn't fill in all the required fields. Once the form has been submitted I would like it to be emailed along with getting stored into a database. ## Deliverables Here is a screen shot of the basic form. If you have any questions or need more details please let me know.