Small payment form

I need this small form I have shown in attachment to be integrated on a WordPress site. The payment calculated in this form will lead a client to [login to view URL] payment gateway when he press Pay Now Button just like PayPal does. So, it is just a third party payment gateway integration once the form has calculated the Number of Guests and Total Amount based on that. The chosen freelancer must have done such forms before and must be good in WordPress too. The Event Price will be fixed on the form BUT can be changed using back end of the site. Rest of the form is self explanatory. No ridiculous bids please and write "i can make form" in your bid so I can be sure you have thoroughly grasped the requirements.