Simple Facebook Form App

This is a simple App with facebook tab It is about to make form for fans to fill , in order to make random chosen fan (winner). the form is so simple (mostly no verification ) and number of fields are so small (about 5 fields ) + human verification . the form should send the data to database (1 table , 5 fields) . 1 buttom to make random function to choose the winner.(for admin). Requirements : The non-fans should see message ( you should like us first ) . its better to have screenshot for the form as a sample . The fans only can apply the form BUT AFTER : ----- we take permission from them to post on their timeline . After success applying , a post should appear in their timeline automatic ( This user apply for our company form ....) , You may use open graph . we need it in high graphic and nice user face interaction . The Form and strings in arabic ( we will give it to you , or make it dynamic if you want and we will translate the string file ) ... + RTL