Design form & tabulate responses

[Razor]

Hi,

I am an Outlook-forms newbie, but I am hoping to leverage
my Access knowledge.

I need to be able to design and email a form to several
ricipents and tabulate their responses into Access.

The message would look like the below with check-boxes:

"Dear {FirstName}

Please let me know who would like to hear speak in the
upcoming convention:

1. Mr. A
2. Mr. B
3. Ms. C
4. Ms. D
5. Ms. E"

{FirstName} would ideally be a merge field.

I need to allow the user to pick multiple speakers.

When I get the response, how do I "send" the response to
Access?

Thanks!

Regards,
Razor