No you can't & there is a good reason for why we don't enable such a feature.

We've been asked about including Forms in the Widgets to gather information but out of respect to the site owner and to prevent phishing, we don't provide the ability to include a form for data collection on sites you don't own.

What you can do is have your Widget Call to Action point to a landing page you own which includes a form to collect User information.

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