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
May 27th 2009Selective ToastmastersCelebrating 10 Year Anniversary
May 1st 1999DTCC Toastmasters North EastCelebrating 20 Year Anniversary