With what issue(s) are you most concerned?
A. Jobs, Economy and Economic Development
B. Taxes
C. Health Care and Veterans Care
D. Public Safety & Crime
E. Education
F. Senior Citizen and Elder Care Issues
G. Government Reform/Corruption
H. Other:

2. What are your specific concerns?



3. What would you like to see done to address these concerns?



Tell us who you are!

Name

Address

City

State

Zip

E-mail Required

Phone (Optional)


Please fill out your name and Address contact information & return (postal or email) this survey to: Michael Puhr at 512 W.~ Woodlawn Ave. Danville, IL 61832

Other comments or questions (Box below)