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Survey

Please indicate below the eight issues which are of most concern to you where issue # 1 is the highest priority.

Issue # 1:

Issue # 2:

Issue # 3:

Issue # 4:

Issue # 5:

Issue # 6:

Issue # 7:

Issue # 8:

 

How would you rate the State Labor Government's performance? (Please select)

Good       Average       Poor

 

More specifically I am concerned about:

 

Optional Information (all strictly confidential):

Name:
Address:
Suburb: Postcode:
Telephone:

 

 

Contact Kim:

9 Lynton Place,
Scoresby VIC 3179
• Phone: (03) 9764 8988
• Fax: (03) 9763 9816

• Email: kim.wells@parliament.vic.gov.au

• Website:
www.kimwells.com.au

Authorised by Kim Wells MP, 9 Lynton Place, Scoresby VIC 3179