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30 Second Survey

Your views are important to me.

    The Issues Please number the four issues that concern you most.

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

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

    About politics Please select one of the following options: (optional) I ALWAYS support the following party

    OR I USUALLY support the following party

    OR

    Your work Please select the option which best reflects your current situation:

    Your Occupation

    Your details Please complete the following details so that I can stay in touch and keep you informed.
    First Name *

    Last Name *

    Address Line 1 *

    Address Line 2 *

    Postcode *

    Home Phone

    Mobile Phone *

    Email *

    Your business Do you own a business and would like my office to keep you informed of Government initiatives or grants?

    YesNo

    Business Name

    Address

    Business Phone

    Industry

    Email

    STAY CONNECTED WITH SCOTT AS THE FEDERAL MEMBER FOR COOK

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    POSTAL ADDRESS

    PO BOX 1306

    CRONULLA NSW 2230

    OFFICE LOCATION

    SUITE 102 LEVEL 1
    30 THE KINGSWAY
    CRONULLA NSW 2230

    PHONE ENQUIRIES

    (02) 9523 0339