Hi everyone

I need help with php script for my form, i want to send e-mails at specified date selected by the users.

I have the html code, but i need the php.

HTML Code:
<p> </p>
<div>
<div align="center">
<table width="100%" cellspacing="1" cellpadding="1">
<tbody>
<tr>
<td class="tableHeader" style="border-bottom: 2px solid #000;" valign="center"> </td>
</tr>
<tr>
<td style="background-color: white;" valign="center" width="60%" height="80%"><form action="send.php" method="POST">
<p> </p>
<center><b>Contact Form</b>
<p>With this contact form you can send an e-mail message in the future !</p>
</center>
<table width="100%">
<tbody>
<tr>
<td> </td>
</tr>
<tr>
<td class="fieldLabel" align="right" width="30%"><b>First Name</b></td>
<td><input class="field" name="first_name" size="27" type="text" value="" /></td>
</tr>
<tr>
<td class="fieldLabel" align="right" width="30%"><b>Last Name</b></td>
<td><input class="field" name="last_name" size="27" type="text" value="" /></td>
</tr>
<tr>
<td class="fieldLabel" align="right" width="30%"><b>Your Email</b></td>
<td><input class="field" name="your_email" size="27" type="text" value="" /></td>
</tr>
<tr>
<td class="fieldLabel" align="right" width="30%"><b>Date to be send the E-mail?</b></td>
<td><select class="field" name="month" size="4">
<option value="1">Ian</option>
<option value="2">Feb</option>
<option value="3">Mar</option>
<option value="4">Apr</option>
<option selected="selected" value="5">Mai</option>
<option value="6">Iun</option>
<option value="7">Iul</option>
<option value="8">Aug</option>
<option value="9">Sep</option>
<option value="10">Oct</option>
<option value="11">Noi</option>
<option value="12">Dec</option>
</select><select class="field" name="day" size="4">
<option selected="selected" value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select><select class="field" name="year" size="4">
<option selected="selected" value="2014">2014</option>
<option value="2015">2015</option>
<option value="2016">2016</option>
<option value="2017">2017</option>
<option value="2018">2018</option>
<option value="2019">2019</option>
</select></td>
</tr>
<tr>
<td class="fieldLabel" align="right" width="30%"><b>Delivery E-mail</b></td>
<td><input class="field" name="email" size="27" type="text" value="" /></td>
</tr>
<tr>
<td class="fieldLabel" align="right"><b>Subject</b></td>
<td><input class="field" name="subject" size="27" type="text" value="" /></td>
</tr>
<tr>
<td class="fieldLabel" align="right" width="30%"><b>Message<br /> <br /> </b></td>
<td><textarea class="field" cols="45" name="message" rows="9"></textarea></td>
</tr>
<tr>
<td> </td>
</tr>
<tr>
<td class="fieldLabel" align="right" width="30%"><input class="button" name="sendButton" type="submit" value="Send!" /></td>
</tr>
<tr>
<td> </td>
</tr>
</tbody>
</table>
</form></td>
</tr>
</tbody>
</table>
</div>
</div>
Screen Shoot of the form.

http://s4.postimg.org/5p2thopr1/form.png

Can anyone help me?