Auto loading SQL database on Website

[James Good]

Hi,

I have a (html) FORM (MEMBERSHIP) on my website to aquire new members names, addresses, city, state, zip and e-mail addresses. I created a (PHP) FORM (processphp) to recieve the data and auto load it to MYSQL database.
the (processphp) webpage gives the message: "Your information has been successfully added to the database" and there is a tab below that reads "CONTINUE".

When I fill in the membership form and submit it - I get the message, "This webpage can not be found".

-------------------------------------------------------------------------

<form action= "process.php" method="post"> MEMBERSHIP
Name:<br><input type="text" name="name"><br>
User Name:<br><input type="text" name="name"><br>
Password: <br><input type="text" name="password"><br>
Address: <br><input type="text" name="Address"><br>
City: <br><input type="text" name="City"><br>
State: <br><input type="text" name="State"><br>
Zip: <br><input type="text" name="Zip"><br>
E-mail: <br><input type="text" name="E-mail"><br>
<input type="submit" value="submit">
</form>
--------------------------------------------------------------
<?
$name=$_POST[ ' name ' ]; process.php
$user name=$_POST[ ' user name ' ];
mysql_connect ("justhost.com/skywayeagles.com","username", "password" )or die (mysql_error());
mysql_select_db (username_MEMBERSDB) or die (mysql_error());
mysql_query ("INSERT INTO 'data' VALUES ( ' $name ', ' user name ' ,)");
?>
"Your information has been successfully added to the database."

Can anyone give me an idea as what is wrong or is there a better way to do this???

Thanks

James