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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


    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?


    Business Name


    Business Phone