PAGE THAT SAVE DATA IN DATABASE & REDIRECT

I want a page like that in the image. All fields must be mandatory. You must enter an email, so if not present @ do not accept the email and highlight the fields not completed in red. If all the fields are completed and click on continue to save all data in a database after redirect to a link with all the parameter data for example: [login to view URL]{firstname}&lastname={lastname } etc ... The Country field must be a list with all the names of the countries in the world in English and choose from all of them. I will use this page more times, for exemple [login to view URL] , [login to view URL] , [login to view URL] , but all data from all page must be saved in same database mysql.