Constituency Survey

I am conducting a constituency survey and would like to know what you think about the following issues.

National Issues Please select 3 issues
	Education	NHS
	Housing	Europe
	Pensions	Immigration
	Crime	Other

Local Issues
Please indicate your key local issues of concern:


Do you believe that Britain should have a referendum on the EU Treaty? Have your say:
Yes, I believe we should have a referendum on the Treaty
No, I do not think we need a referendum

Your Details
Name
Address
Phone No
Email