Unifi WiFi User Portal

We need a very basic WiFi portal built for a Ubiquiti Unifi Wireless Site. We want users to provide first name, last name and email. Name is optional, but email is mandatory. Basic email format validation is required (check that there's an @ sign and that it ends with common email address suffixes) Once submitted, we want the form information emailed to an internal address via SMTP (the SMTP server exists, but uses GMail's non-standard ports) Look and feel will have a basic logo. Nothing else. Super simple Some examples here [login to view URL] [login to view URL]