30 SECOND SURVEY Question Title * 1. YOUR DETAILS First Name * Surname Street Address * Town * State Post Code * Email Address Mobile Phone Number * Question Title * 2. THE ISSUESPlease number the four issues that concern you most Question Title * 3. IN PARLIAMENTIf you could raise one issue in the Federal Parliament, what would it be? Question Title * 4. OUR COMMUNITYIf you could fix one problem in our local area, what would it be? Question Title * 5. STAYING IN TOUCHHow do you prefer to be contacted? Mail SMS Email Question Title * 6. YOUR WORKPlease provide information on your work Full-time Part-time Self-employed At home parent Unemployed Student Age Pensioner Disability pensioner Self-funded Retiree Your occupation Question Title * 7. ABOUT POLITICSPlease select one of the following options: (optional) I ALWAYS support the following party - Liberal I ALWAYS support the following party - Labor I ALWAYS support the following party - Greens I ALWAYS support the following party - Independent/Other I USUALLY support the following party - Liberal I USUALLY support the following party - Labor I USUALLY support the following party - Greens I USUALLY support the following party - Independent/Other I DON'T Support any political party Thank you for completing this survey. Authorised by Dan Tehan MP, Liberal Party of Australia, 190 Gray Street, Hamilton VIC 3300 Done
