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1. With what issue(s) are you most concerned?
A. Jobs/Economy B. Health Care
C. Education D. Crime/Public Safety
E. Veterans Issues F. Ethics in Government
G. Environment H. Other
2. What are your specific concerns regarding these issues?
3. What do you think should be done to address your concerns?
4. What other ideas would you like to share?
Name: Email:
Address: Phone: