Hope you don't mind, but I went ahead and built you an example of what I would use. I remember when I was first learning about web development. It seemed like a very big hump at first, until I got some traction through the help of others.
I laid out the form using some best practice stuff that I like to do. CSS for the the text and link formatting, JS alerts for empty fields to catch users before submitting, changes to the buttons used, and some reformatting of your layout.
You can take a look at my functional example here: http://benconley.net/htest.html
It submits to you, and redirects back to your site. If you like it you can just view the source, copy it to your own text file, and use it as a reference as you get more experienced with web pages.
Good luck, and I'll try to offer suggestions when I can, if you have any questions.