Add New Record in mysqli Database

Biographical Information
First Name
Last Name
Full Mailing Address
Contact E-Mail
Contact Phone
xxx-xxx-xxxx
Contact Cell
xxx-xxx-xxxx
Club Name or Organization
Designation
Brief Biography:
Presentation Information
1. Select the developmental track which your presentation represents:
Personal Development
Professional Development
Club Development
2. Title of your presentation and anticipated length (45 min minimum - 50 min maximum)
3. Have you presented this workshop before? If yes, when and where?
4. Briefly describe your presentation (outline and benefits of attending your workshop)
Purpose of workshop:
Further goals of this workshop are to:
Benefits:
This workshop fits into the theme by:
5. Explain why you are qualified to present this workshop.
6. Audio/Visual/Equipment Requirements. Please tell us your needs (check all that apply) :

Projector/Screen
Flip Chart/Easel/Markers
Additional Requirements:

You will be responsible for providing additional equipment and supplies, such as laptops, handouts or other workshop materials. The Education Co-Chairs must be informed of any changes in your Audio/Visual requirements no later than two weeks prior to the conference. Last minute changes will not be accommodated.



Charter DateClub Name/Club Number
October 21st 2019AHS Toastmasters Club
7657889
November 20th 2019New World Toastmasters Club
7431646
November 12th 2019RobustWeatlh Toastmasters
7629055
December 16th 2019Oratory Toastmasters
7684765
December 27th 2019NJR Toastmasters
7606611
December 31st 2019Princeton Power Presenters
7619827
March 9th 2020Mitsui Toastmasters Club
7764490
March 1st 2020Woodland Park Toastmasters
7745531
January 21st 2020DFJ Toastmasters
7666903