A simple site built

I need a simple site built, where on the main page there is a form with these options: Name: Country: State: Start Date: End Date: Section (1 of 3 options to choose): Social Cause, Commercial, Other Cause – which will direct the form entry. Title: Description: Price: Email: Tel: Security Code: Submit button Each new form entry will post in one of three of the inside pages, depends on the "Section" selected on the form (social cause, commercial, other cause). These will post as comments with the relevant details inputted in the form (up to 300 characters). Next to the form on the main page will be a RSS feed with the latest comments/form entries. The 3 inside pages (social cause, commercial, other cause) will just be listings/comments from the form, the newest ones on top. Attached is a picture of what I'm looking for