Magento Customer Group Registration Module

Hello, I have a rush job I need within 24 hours. It should be pretty straight forward. It is a Magento module you will have to deliver to me and needs to have the following. Requirements: Create a new registration page, this will be a phtml page that I can include on an existing CMS page. The form must have 2 additional fields and a terms and conditions box that needs to be accepted to continue. Once submitted, the registration will complete, the user will be logged in, set as customer group 'X' and redirected to /[login to view URL] Admin Panel Controls [ General ==============================================] Enable [ Yes/No] Form URL [ /special-url ] Additional Fields [ field one, field two ] ^ Separate additional fields with comma Assign Customer Group [ Please Choose Group ] ^ This will be the default customer group for this form Redirect Once Complete [ /[login to view URL] ] ^ Leave blank to redirect to the account page Require Terms and Conditions: [ Yes / No ] Terms and Conditions: [ Text Box ] Front-end View, based off default reg form Create An Account First Name: [ ] Last Name: [ ] Email Address: [ ] ..Additional Fields.. Password: [ ] Confirm Password: [ ] Terms and conditions [ ] [ ] [ ] [ ] [ ] [X] I agree to the terms and conditions [ Create Account ]