The short answer is no.
This article from Campaign Monitor explains why in more detail: http://www.campaignmonitor.com/resources/will-it-work/forms/
The upshot is that many email clients don't trust forms in emails, and so you cannot rely on either how the form will be displayed or how the form will function.
Please do not attempt this, as it will confuse and alarm the PIN sources who receive your email.
(If you miraculously discover a solution, please add comments below.)
A quick illustration from the Campaign Monitor article of how various email clients handle forms in emails: