Your views matter to me. Please take a moment to fill out the survey below.
Select the issues most important to you (ranking
them highest  to lowest). Please select a minimum of
To clear a selection,
reselect the issue again.
If you could fix any problem in our local area, what would it be?
Please select ONE of the following options:
I ALWAYS support the following party:
I USUALLY support the following party:
Your Details (Please note, your details will be kept confidential and not shared with any third party). All details are required.
First Name :
Street Address :
Feel free to contact me?:
My best contact method:
Yes, I am willing to help Max in this election (please check box)