First name
Last name
Email
Mobile
1.
What issues are most important to you? (e.g., housing, environment, infrastructure, growth, etc.)
2.
What changes would you like to see in politics?
3.
Would you vote for an independent candidate in the federal seat of Fairfax?
Please select
Yes
No
4.
Please explain your answer above
5.
And finally, how old are you?
Please select
Under 18
18-30
31-45
46-65
65+