<div class="col-sm-12">
  <form id="SubmissionForm" action="insert.php" method="POST" role="form">
    <div class="form-group">
      <label for="FirstName">First Name *</label>
      <input type="text" class="form-control" id="FirstName" placeholder="" name="first_name" value="" data-error="Please enter a valid first name." required maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="LastName">Last Name *</label>
      <input type="text" class="form-control" id="LastName" placeholder="" name="last_name" value=""  data-error="Please enter a valid last name." required maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="Email">Email address *</label>
      <input type="email" class="form-control" id="Email" placeholder="" name="email" value="" data-error="Please enter a valid email address." required maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="Age">Age *</label>
      <input type="text" class="form-control" id="Age" placeholder="" name="age" value="" data-error="Please enter a valid age." required maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="Phone">Phone *</label>
      <input type="text" class="form-control" id="Phone" placeholder="" name="phone" value="" data-error="Please enter a valid phone number." required maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="StreetAddress">Street Address *</label>
      <input type="text" class="form-control" id="StreetAddress" placeholder="" name="street_address" value="" data-error="Please enter a valid street address." required maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="Suburb">Suburb</label>
      <input type="text" class="form-control" id="Suburb" placeholder="" name="suburb" value="" maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="City">City *</label>
      <input type="text" class="form-control" id="City" placeholder="" name="city" value="" data-error="Please enter a valid city." required maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="Postcode">Postcode *</label>
      <input type="text" class="form-control" id="Postcode" placeholder="" name="postcode" value="" data-error="Please enter a valid postcode." required maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="Country">Country *</label>
      <input type="text" class="form-control" id="Country" placeholder="" name="country" value="" data-error="Please enter a valid country." required maxlength="255">
      <div class="help-block with-errors"></div>
    </div>

    <div class="form-group">
      <label for="FindUs">Where did you hear about us?</label>
      <input type="text" class="form-control" id="FindUs" placeholder="" name="findus" value="" maxlength="255">
    </div>

    <div class="form-group">
      <div class="gender-label">Gender *</div>
      <div id="Gender">
        <div class="radio" style="margin-top:0px;">
          <label>
            <input type="radio" name="gender" id="Female" value="F" required>
            Female
          </label>
        </div>
        <div class="radio">
          <label>
            <input type="radio" name="gender" id="Male" value="M" required>
            Male
          </label>
        </div>
      </div>
      <div class="help-block with-errors"></div>
    </div>

    <hr>

    <div class="form-group">
      <button type="submit" class="btn btn-primary">SUBMIT</button>
    </div>
  </form>
</div>

<?php
//include 'connect.php';
$servername = "servername";
$username = "username";
$password = "password";
$dbname = "dbname";

$conn = new mysqli($servername, $username, $password, $dbname);

if ($conn->connect_error) {
    die("Connection failed: " . $conn->connect_error);
}

if($_SERVER['REQUEST_METHOD'] == 'POST'){
    $host_email = 'email@email.com';
    $host_name = 'name';

    $first_name = $_POST["first_name"];
    $last_name = $_POST["last_name"];
    $email = $_POST["email"];
    $gender = $_POST["gender"];
    $age = $_POST["age"];

    $phone = $_POST["phone"];
    $findus = $_POST["findus"];
    $street_address = $_POST["street_address"];

    $suburb = '';
    if(isset($_POST["suburb"]) == ''){
        $suburb = 'n/a';
    }else{
        $suburb = $_POST["suburb"];
    }

    $postcode = $_POST["postcode"];
    $city = $_POST["city"];
    $country = $_POST["country"];

    $agree = '';
    if(isset($_POST["agree"]) == ''){
        $agree = 'No';
    }else{
        $agree = 'Yes';
    }

    $sql = "INSERT INTO `dbname`.`tablename` (`first_name`, `last_name`, `email`, `gender`, `age`, `phone`, `findus`, `street_address`, `suburb`, `city`, `country`, `postcode`, `email_subscribe`, `date`)
    VALUES ('$first_name', '$last_name', '$email', '$gender', '$age', '$phone', '$findus', '$street_address', '$suburb', '$city', '$country', '$postcode', '$agree', NOW());";

    if($conn->query($sql) === TRUE) {
        $unique_id = $conn->insert_id;  //get the id from the last db insert

        $name = $first_name . ' ' . $last_name;

        $phone = $phone;

        require 'PHPMailerAutoload.php';

        $mail = new PHPMailer;

        //$mail->SMTPDebug = 3;                                         // Enable verbose debug output

        $mail->isSMTP();                                                // Set mailer to use SMTP
        $mail->Host = 'host';                                           // Specify main and backup SMTP servers
        $mail->SMTPAuth = true;                                         // Enable SMTP authentication
        $mail->Username = 'username';                                   // SMTP username
        $mail->Password = 'password';                                   // SMTP password
        $mail->SMTPSecure = 'tls';                                      // Enable TLS encryption, `ssl` also accepted
        $mail->Port = 587;                                              // TCP port to connect to

        $mail->setFrom('email@email.com', 'email');
        $mail->addAddress($host_email, $host_name);                     // Add a recipient - name is optional
        $mail->addAddress($email, $first_name.' '.$last_name);          // Add a recipient - name is optional
        $mail->addReplyTo('email@email.com', 'email');

        $mail->addAttachment('map.pdf');                                // Add attachments
        $mail->isHTML(true);                                            // Set email format to HTML

        $mail->Subject = 'Registration ID: #'.$unique_id;

        $message = '<p><span>Name:</span><span><strong>'.$name.'</strong></span></p>
        <p><span>Email:</span><span><strong>'.$email.'</strong></span></p>
        <p><span>Age:</span><span><strong>'.$age.'</strong></span></p>
        <p><span>Gender:</span><span><strong>'.$gender.'</strong></span></p>
        <p><span>Phone Number:</span><span><strong>'.$phone.'</strong></span></p>
        <p><span>Street Address:</span><span><strong>'.$street_address.'</strong></span></p>
        <p><span>Suburb:</span><span><strong>'.$suburb.'</strong></span></p>
        <p><span>City:</span><span><strong>'.$city.'</strong></span></p>
        <p><span>Country:</span><span><strong>'.$country.'</strong></span></p>
        <p><span>How did you find out about us?:</span><span><strong>'.$findus.'</strong></span></p>
        <p><span>Agree to email?:</span><span><strong>'.$agree.'</strong></span></p>
        <hr>';

        $email_copy = "<p>Thank you for registering.</p><p><strong>Your Registration Number is #".$unique_id."</strong></p>";

        $mail->Body = $message.$email_copy;

        $mail->AltBody = $message.'<br><p><span>Name:</span><span><strong>'.$name.'</strong></span></p><p><span>Age:</span><span><strong>'.$age.'</strong></span></p><p><span>Email:</span><span><strong>'.$email.'</strong></span></p><p><span>Gender:</span><span><strong>'.$gender.'</strong></span></p>';

        if(!$mail->send()) {
            header("Location:error.php");   //if mail fails
        }
        else{
            header("Location:thankyou.php");
        }
    }else{
        echo("Error description: " . mysqli_error($conn)); //if db insert fails
    }
}
$conn->close();
?>