Registration Form in a Word Doc

I'm looking for a way to distribute a Word document so that when it is first opened, the user is presented with a form that they must complete (name, company, email, phone, etc). When they compete the form it then automatically hits a webserver and logs the data (or send an email if this can be done in the background with out user intervention or having a user cancel it. It doesn't have to be fool proof but, 95% of the users should not be able to defeat it (meaning view the doc without registering). Also, I'm assuming this will use VBA or macros, if the user has this turned off, they should get an error, or be asked if they want to turn it on (and of course, not be able to get to the doc unless they register). I am looking for a sample document with a sample form. I can customize from there, or have you do more work. (Using a PDF doc, instead of Word, would be fine as well) Thanks.