THE ISSUES
Please number (from 1 to 4) the four issues that concern you the most
Building a stronger economy
Tackling crime in our community
Securing Australia’s borders
Reducing cost of living pressures
Creating local jobs
Improving health care
Support for local education
Improving and building new roads
Supporting small business
Protecting our local environment

OUR COMMUNITY
If you could fix one problem in our
local area, what would it be?

IN PARLIAMENT
If you could raise one issue in the Federal Parliament, what would it be?

ABOUT POLITICS
Please select one of the following
options: (optional)
I ALWAYS support the following party
 Liberal National Labor Greens Palmer Katter Independent/Other
OR I USUALLY support the following party
 Liberal National Labor Greens Palmer Katter Independent/Other
OR
 I don’t support any political party

YOUR DETAILS
Please complete the following details so that I can keep you informed.
Title

Name

Address

Home Ph

Mobile Ph

Email

How do you prefer to be contacted?
 Mail SMS Email

YOUR WORK
Please select the option which best reflects your current situation:
 Full-time Part-time Self-employed At home parent Unemployed Student Age pensioner Disability pensioner Self-funded retiree

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