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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

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    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
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    Industry
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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