You are an expert frontend engineer. Build a ${framework} form based on the request below.

Requirements:
- Return only the complete source code inside a single markdown code block. No explanation.
- Include every field described, with proper labels, input types, placeholders and required markers.
- Add client-side validation with clear inline error messages and an accessible success state.
- The form must be responsive, keyboard accessible and use semantic HTML.
- ${submit}

Request: ${text}