a base html page to "PraOndeVou"(nowhere to go)

I´ve an idea to put in the air a facebook app called "Pra Onde Vou?"(nowhere to go?) and i ´ve no idea about the design. The app basic idea is to help travelers to create routes and to ask friends for opinion using the facebook. It´s very simple and the page needs to have have the following elements. 1 - two input fields, one to put an addres and another to put some description of the place. 2 - a map to show the route points 3 - a list of points to edit or remove existing places. 4 - a save button. 5 - a facebook share button. 6 - a "ask for opinion" button. The logo image is attached.