What would be the easiest way to allow users to sign an online petition?

How could I allow users to sign there name onto an online petition... What I am thinking is if they want to sign it they fill out a short form to fill out their name, age,City, and State information. And that information goes straight to that same page. And try to minimize repeat information. any ideas???

 

Best Answer - Chosen by Voters

Hi,
Add email to your form too. It should be a easiest way. But caution of spam form fill up engines, Because you are not provide human test and it can be hacked by one of this engines.