Survey

1. Which of the following local issues are causing you most concern?

Please choose:

 Council Tax
 Television Reception
 Litter
 Public Transport
 Youth Facilities
 Green Belt
 Graffiti
 Leisure Facilities
 Roads and Traffic
 Social Services
 Anti-Social Behaviour
 Employment

If other please specify:

2. Which of these national issues are causing you most concern?

Please choose:

 National Health Service
 Civil Liberties
 Crime
 European Union
 Roads and Transport
 Terrorism
 Climate Change
 War in Afghanistan
 Immigration
 Rising Prices
 Economy and the Cuts
 Education

If other please specify:

3. Do you approve of the Coalition Government?

 Yes No Don't Know

4. Do you feel the new Government is dealing with the financial problems of our nation...?

 Very Well Satisfactorily Not Well Don't Know

5. If you could improve one thing about the local area what would it be?

Please enter your details

First Name * 
Surname * 
Tel 
House Name/Number 
Street 
Town 
Postcode 
Email *