Simple Php Registration Form 2

Simple Php Registration Form 2
I need this registration php form:

The data will be inserted in a mysql database (one column for each field)

The columns will have spanish names and will be:

Nombre (Name)
Telefono (Phone)
Referencia (Reference Number)
Fecha_Pago (Date of payment)
Personas (Number of passengers)
Salida (Departure)
Regreso (Return)

When the user press the button “Make my reservation” he will see all the data and then press a confirm button.

For all the registrations one mail will be sent to the user with copy to the webmaster.

This form needs to be made immediately.

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