k, here's how i would do it.
First, add the necessary textboxes.
Put them in a single form.
Have the form action be the page they want to view.
In order to view the page, all variables (name/address/etc.) must be posted.
When those things are posted, PHP can be used to send an email to you containing the information. Then have it store either a cookie or a session variable for the user. Then require the session or cookie variable to be set in order to view the page (use a redirect or error page if the variable is not set).
Sending mail in PHP:
PHP Sessions and Cookies:
NOTE: session variables are destroyed when the client leaves the site or closes the browser. cookies are destroyed when they either expire or the user deletes them.