Your Views on the issues in Lorem & Ipsum

Which of the following are the most important local issues to you?
(pick up to 3)

Affordable housing Antisocial behaviour Crime and policing Roads and potholes Buses and public transport Parking availability Waste collection Litter and graffiti Overdevelopment Local environment

Other (please state)

Which of the following are the most important national issues to you?
(pick up to 3) *

Cost of living Jobs / the economy The NHS Social care Pensions Crime and policing Transport infrastructure Schools / education Climate change Immigration Brexit Defence and security International development

Other (please state)

How did you hear about this survey?

Leaflet through my door Letter in the post Spoke to volunteer Word of mouth Facebook Email Other online Other offline

Would you like to be involved with my campaign?

Yes - send me more details No

First Name

Last Name

Phone Number

House Address

Post code

Is there anything else I can help with?

Data Processing Permission

I agree to Joanne Bloggs MP using the information I have provided and using it to understand what issues are most relevant to me and to contact me about events and other activities. I understand I can opt out from communication at any time. To understand more about about how the website uses personal data, please see privacy policy

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