First name
Last name
Email
Mobile
1.
Your gender
Please select
Female
Male
X
2.
What is your age range?
Please select
Under 25
25-40
41-55
56-70
Over 70
3.
What suburb do you live in?
4.
Are you of Aboriginal or Torres Strait Islander origin?
Please select
Yes
No
5.
What are your main local issues and concerns?
6.
How would you like these local issues addressed?
7.
What are you main issues and concerns at a national level?
8.
How long have you lived on the Sunshine Coast?
9.
What do you think makes for a really good political representative?
10.
Do you feel you have a say in the way you are represented?
Please select
Yes
No
Don't know
11.
What would make you feel better represented?