Need a App develop (simple)

[rr212]

Hey guys, I need an app that will allow users to register/and upload a picture from their album

the feild


First Name:
Last Name:
Address:
City:
State:
Zip:
Tel:
Email:
Upload a picture from gallery:

upload/stored on mySQL database, image will be stored on a host...

shoot me PM if you can work on this? will pay.