PHP - Subscription Help

Hi is there someone who can help me with the following?

I need a script within someone can subscribe to a website. It needs to fill in personal info (like name address and city), a option to fill in a second address, confirmation email and eventually a option to create a login to personal part (not necessary).

I tried several scripts but nothing is really what I need. Can someone help me by showing where to start or has someone a simple script I can use?

Kind regards,
Rudolph

I am new to PHP. I have just developed a contact us form successfully in PHP. So when some fill it the information will e-mail to me automatically.
Know I need to suscription form, When someone fill the subscription form then his all information goes to my email address and as well as when he select a specific country from a drop down list the information will e-mail to that country customer,because every country has a different e-mail address.

Know i need a code for that can any body please help me.
I am placing HTML and PHP Code.

HTML CODE:

  <form action="contact.php" method="post">
               <ul>
                   <li><label>Name: </label>
                       <input id="name" name="name" class="text" />
                    </li>
                    <li><label>E-mail: </label>
                       <input id="email" name="email" class="text" />
                    </li>
                     <li><label>Subject: </label>
                       <input id="subject" name="subject" class="text" />
                    </li>
                   
                    <li>
                    <label>
                          <select name="select" id="select">
                            <option>Germany</option>
                            <option>United States of America</option>
                            <option>Canada</option>
                            <option>England</option>
                          </select>
                          </label>
                     </li>
                   
                    <li><label>Comments: </label>
                     <textarea id="message" name="message" rows="6" cols="50"></textarea>
                     </li>                     
                       <li class="buttons">
             <input type="image" name="imageField1" id="imageField1" src="images/send.gif" />
          </li>
                </ul>
                </form>
PHP CODE

<?php

if(!$_POST) exit;

$email = $_POST['email'];


//$error[] = preg_match('/\b[A-Z0-9._%-]+@[A-Z0-9.-]+\.[A-Z]{2,4}\b/i', $_POST['email']) ? '' : 'INVALID EMAIL ADDRESS';
if(!eregi("^[a-z0-9]+([_\\.-][a-z0-9]+)*" ."@"."([a-z0-9]+([\.-][a-z0-9]+)*)+"."\\.[a-z]{2,}"."$",$email )){
   $error.="Invalid email address entered";
   $errors=1;
}
if($errors==1) echo $error;
else{
   $values = array ('name','email','message');
   $required = array('name','email','message');
   
   $your_email = "kuhashmi@gmail.com";
   $email_subject = "New Message: ".$_POST['subject'];
   $email_content = "new message:\n";
   
   foreach($values as $key => $value){
     if(in_array($value,$required)){
      if ($key != 'subject' && $key != 'company') {
        if( empty($_POST[$value]) ) { echo 'PLEASE FILL IN REQUIRED FIELDS'; exit; }
      }
      $email_content .= $value.': '.$_POST[$value]."\n";
     }
   }
   
   if(@mail($your_email,$email_subject,$email_content)) {
      echo 'Message sent!';
   } else {
      echo 'ERROR!';
   }
}
?>

PLZZZZ Help me i need it urgently. I will be thankful to you if you provide me the cide.

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http://www.phpfreaks.com/forums/index.php?topic=321119.0