Add New Record in mysqli Database

Club Name
Date Captured
Member 1 Who Attended
Member 2 Who Attended
Member 3 Who Attended
Contact Name
Contact E-Mail
Contact Phone xxx-xxx-xxxx
Contact Cell xxx-xxx-xxxx
Story

Charter DateClub NameAnniversary
March 1st 1994Conquerors ClubCelebrating 25 Year Anniversary
March 11th 2014Hudson VoiceCelebrating 5 Year Anniversary
March 24th 2009Novo Nordisk Toastmasters ClubCelebrating 10 Year Anniversary