Huge PHP email form needed

I need to create a form nearly identical to this [link removed], but more secure and with PHP. I’m using an online contact form generator, but it’s very basic (and doesn’t include dropbox boxes). I’ve been working very slowly, using the basic fields available and adding more manually within Dreamweaver MX. I lack PHP knowledge, so I’m copying and pasting, making sure the fields I add match up everywhere across the files.

If you can help me out, I’d really appreciate it! This might be a driving factor to get me to learn some HTML, CSS, and PHP.

Update: Thanks to Eric for basically doing the chore for me. You rock, man!