220 Pages PDF Catalog | Mail me Only the FORM Page

Dear All,
I have a 220 pages part catalog built in InDesign CS6.
The 4th page is a FORM for Dealers (Application form).
The SUBMIT button mailing it to myself.
So I export the entire Catalog [interactive PDF] (220 pages) and sharing it with my audience. [they can download it from my website].
I want the People if they filling in the page 4 [PDF form] anf hit SUBMIT, only mail me (Kolors@ me.com) the page 4 instead of the 220 pages.)
Any Good Idea?
Than You
Kolos
Kolors@ me.com

Step 1: print the first page to tray 1
Step 2: print the other pages to a different tray

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