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* 1. What years did you and/or your family,  live in the Hope Valley or Wattleup townsite or rural areas?

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* 2. Have you or any of a family member been diagnosed with any significant  illness between the years of 1990 til now? Please state the specific illness for eg: Cancers, Respiratory Illness, Auto Immune Disease etc

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* 3. What year (if known) were you/they diagnosed and what was the outcome?

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* 4. Do you believe that this illness could relate to living within, or in the proximity, of the  Kwinana Air Buffer Zone? Please add your reasons why.

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* 5. Do you give permission for your data to be recorded and collated into a spreadsheet? You can choose to remain anonymous by noting in comments.

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* 6. If YES, can you please provide the address YOU LIVED AT  in the townsite or  rural area and your contact details.

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