JQuery Modal Form

JQuery Modal Form

Hello all,
I am trying to create a small table, with the following specifications:
1. there will be a button that user will click (Enter Your Details)
2.Under the button, there will be three columns with the following headings (Full Name | Password | emailAddress)
3. When the button in item 1 (above) is clicked, it will open a modal form
4. The modal form will contain a form with the following details (username | password | email
5. There will be two buttons below the form (Submit and Cancel)
6. When the submit button in numer 5 is clicked, it will populate whatever users enter in the form in number 4 under each headings in number 2.
7. When the Cancel button is clicked, it will cancel whatever user is trying to enter in the modal form.
7. Assuming many users enter their details, all of them will be retain and one person can use the form may times (No restriction on this).

I have tried modifying JQuery Modal Form but no success - http://jqueryui.com/dialog/#modal-form

Please any help on this will be appreciated.