Facebook competition application on pagetab

I need to have a competition implemented to a Facebook app that is called "Static Html - Thunderpenny" ([login to view URL]) I have the design (a single page) that needs to be turned into HTML. There is a simple contact form on the page where the user can enter their name, age, sex and e-mail address, and tick off a box to sign up for newsletter. These information should be send to the clients inbox. I will insert the HTML myself to the app on Facebook, so I only need the HTML.