Urgent help needed!

Is there anyone willing to guide me through writing a code for form that involves JavaScript, CSS, and XHTML? I have to replicate a form and also have validation with JavaScript. I'm such a beginner at this and done very minimal work. I've worked with all three, but I don't know where to start with this, thus I'm not posting a code. I'm going to need a lot of help, even though it's a really simply form, so if you can help me could you please email me at seifer_alamasy@yahoo.com. I'M DESPERATE!