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Your local Conservatives are conducting a survey to see how YOU think our area could be improved. Please take a few minutes and answer the questions below. Thank you for your help.

Question: Which 3 of these national issues concern you or your family at the moment?
Education Health Service Pensions
Crime/Law & Order Transport Defence
Other (Please specify)


Question: What are the local issues that concern you?
Roads Refuse Collection Council Tax
Other (Please specify)


Question: Are there any issues that particularly affect your own street or area?


Question: Have you voted Conservative in the past?
Yes No


Question: Do you believe the Labour Government has let you down?
Yes No
If yes, in what particular way?


Question: Who did you support at the General Election?
Conservative Labour Liberal Democrat
UKIP Other Did not vote


Question: Who would you support in Local Elections?
Conservative Labour Liberal Democrat
UKIP Other Did not vote


Please use the space below to let us know about any other issue that is currently causing you or your family concern:


Name:
Address:
Post Code:
Phone:
Email:


Help our fight to improve the area:
Local Conservatives work all year round to help improve our area. Tick all or one of the boxes below if you would like to help, and we will be in touch with you. Thank you.
delivering some leaflets near your home
joining the local Conservatives
making a donation

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