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PHP and MySQL - INSERT INTO customer

Title
Last Name
First Name
Date of Birth yyyy-mm-dd

<!-- addData.php -->

<?php
  require "../secure.php";    // Contains host, username and password

  // IF ALL THE INPUT FIELDS ARE NOT BLANK ...	
  if (($_POST['title']         != "") && 
      ($_POST['last_name']     != "") && 
      ($_POST['first_name']    != "") && 
      ($_POST['date_of_birth'] != ""))
  {
    $link = mysql_connect($host,        // Host name
                          $user,        // User name 
                          $password)    // User password
    or die("<h5>Could not connect: </h5>" . mysql_error());
  
    if (mysql_select_db ($database))
    {
      $sql = "INSERT INTO customer 
      (title, last_name, first_name, date_of_birth) 
      VALUES 
      (\"$_POST[title]\", \"$_POST[last_name]\", \"$_POST[first_name]\", \"$_POST[date_of_birth]\")";
	  
      mysql_query($sql, $link);
    }    
  }
?>

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<META name="description" content="Tutorial for Linux, Apache, MySQL, SQL and PHP - LAMP">
<META name="keywords" content="tutorial, linux, apache, mysql, php, code, sql, lamp, lesson, lessons, example, examples, beginner, beginners, beginners' beginner's">
<title>PHP and MySQL - INSERT INTO customer</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<link href="style.css" rel="stylesheet" type="text/css">
</head>

<body>
<table border="1" cellspacing="0" cellpadding="4">
  <tr valign="top"> 
    <td><?php include "nav.php"; ?></td>
    <td>
<h1>PHP and MySQL - INSERT INTO customer</h1>

<?php 
  echo "<p>".$sql."</p>\n";
?>

<form name="form1" method="post" action="">
  <table border="1" cellspacing="0" cellpadding="2">
    <tr> 
      <td><div align="right">Title</div></td>
      <td><input name="title" type="text" id="title"></td>
    </tr>
    <tr> 
      <td><div align="right">Last Name</div></td>
      <td><input name="last_name" type="text" id="last_name"></td>
    </tr>
    <tr> 
      <td><div align="right">First Name</div></td>
      <td><input name="first_name" type="text" id="first_name"></td>
    </tr>
    <tr> 
      <td><div align="right">Date&nbsp;of&nbsp;Birth yyyy-mm-dd</div></td>
      <td><input name="date_of_birth" type="text" id="date_of_birth"></td>
    </tr>
    <tr> 
      <td colspan="2"><div align="right"> 
        <input type="submit" name="Submit" value="Submit">
      </div></td>
    </tr>
  </table>
</form>

<?php
  require ("viewCode.php");                        // Contains the viewData() code
  viewData();                                      // Displays the SQL query results
  dump_page(basename($_SERVER[SCRIPT_FILENAME]));  // Display the code of this page
?>

    </td>
  </tr>
</table>

</body>
</html>