Create a Contact List Program for an Existing Blog Page

I want to build a contact list by giving away a free product and I want to able to change the product on occasion my self. I need a program to keep track of contact list. I want to remove the contact program that is presently on by blog and replace it with this new system, check out what I have by going to [login to view URL] Please see a sample of what I'm looking for at this blog page [login to view URL] I want mine to be at the top of the page minus and look like this minus the errors. I want to give them a Heart Centered Guided Meditation so I want to post a cd cover with a place to enter the contact information below it. Please look at this blog as a sample for what I want[login to view URL] and I have attached the book cover and then if you could have a cd coming out and the message read: Receive Your Free:" Heart Centered Mediation", plus enter a weekly drawing for a free Unlimited You Coaching session. Enter your name and email address Name Primary emai Submit Thank you. Loretta