Cynthia Lui MP
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Community Survey
What's Important To You?
Issue
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How would you rate the importance of this issue?
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- Please select -
1 - Not Important
2
3
4
5 - Very Important
How has this issue affected you/your family/community?
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How long have you been affected by this issue?
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What change would you like to see happen?
*
What are the long term benefits?
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Your Details
Name
*
Address
Phone
Mobile
Email
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Are you enrolled to vote?
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- Please select -
Yes
No
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