Look good, neat and kind of pro in desktop, but it needs some more work for mobile.
Using placeholder for text fields, very good.
using shadow on top white text to bring more contrast, very smart, and very good.
This is not critical, but I would use a little more dark colour for text to bring more contrast.
Radio and checkbox buttons have no associated
label to them(broken linking), c’mon! please, always use label to host a text to a radio/checkbox.
I think the should be a little more spacing between radio buttons. placing them vertically also work too and more common.
No any default option for the combo box, good!
“submit” and “remind me later” buttons have different height! not good! they should have at-least same height, if you go for same width too, so awesome. Also bring more space between them
About the mobile, it’s broken when screen goes a little more small, all becasue you used absolute constant values for text fields and other elements(200px for example). This causes scrolling horizontally which is not very nice!
Instead of 200px, use something else like 100%, and control the max value using parent element or another unit like inch.
vertically flow layout for radio buttons look better for mobile device, current layout looks broken , check:
Also note the not well spacing between elements. in mobile, input elements especially should come with good spacing with other objects.
I would apply a little more line-height for footer two line text.
Also this is good to place horizontal line between each section of form (e.g. after and before radio buttons)
For mobile also, you may reducing the margin to screen edge to utilize more space for page content.
Keep going on great work, happy programming