Date Picker

We require a date picker with a start and finish dates - ie days (1-31) months and years (2011-2014) with an editor function so we can update the years. Is to go into a wordpress site so should be a compatible plugin for this. To view exactly what we need see the screen shot. Will need the other fields as well ie a form to fill out so someone can enter their name, contact details etc. Design will need to fit in with existing website.