just google "php tutorials" - and you will find plenty of sites such as this: http://www.w3schools.com/php/default.asp
i'm afraid you will have to actually take some time and at least learn the basics of php - tutorials can be fairly helpful and there are several good books for beginners out there too.
the other option would be, that you can hire someone to do this for you. while this is not a very hard task, i highly doubt that someone here will whip this up just like that; and because of that, you should maybe sit down for a day or two and see if you can't come up with a solution yourself. dont worry about the login script yet - try to get your form working first.
the least you can do is post whatever you have so far and give a bit more background information about your project (f.ex. where/if the data is stored and where the "places" are, that it's supposed to show up at).