Add New Record in mysqli Database

Club Name (Must Match Club Name on Invitation)

Enter Your Name (last, first format please)

Enter Passcode (Must Match Passcode from invitation)

Enter Name and email of Club Member Who will Represent the President
(Must be a member of your club)
Name:
email:
Enter Name and email of Club Member Who will Represent the Vice President
(Must be a member of your club)
Name:
email:

Charter DateClub NameAnniversary
January 27th 2014Iselin IcebreakersCelebrating 5 Year Anniversary