Collect email addresses at a tradeshow - windows

Need a very simple Windows program that will collect email addresses on a laptop/netbook at a tradeshow. People will walk up, enter their name and email address and press/click enter - that's it. The info will be written to a csv or excel file for later export. - the program, while running, will fill the whole screen with the input form (we may include a logo and a one-line marketing message. Background image and logo would be nice - the program will not respond to ESC key or ALT F4 (if possible) to avoid someone exiting the program and playing with the computer. - information to collect will be First Name, Last name and email. MUST BE DELIVERED IN TWO DAYS MAX - DON'T BID IF YOU CANNOT DELIVER IN TWO DAYS.