Manna Gum Community House - Community Survey

Question Title

* 1. What is your postcode?

3960

3959

3962

3966

3965

3956

Other (please specify)

Question Title

* 2. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

I'd rather not say

Question Title

* 3. Have you heard about Manna Gum Community House services and activities?

Yes

No

Question Title

* 4. Have you participated in any activities or services at Manna Gum Community House?

Yes

No

Question Title

* 5. If yes, please list which activities or services

Question Title

* 6. What services and activities would you like Manna Gum to be providing?

Continue the same

Add something

Please list your ideas

Question Title

* 7. Would you like more information?

Yes

No

Question Title

* 8. Would you like to join a focus group to give us more feedback?

Yes

No

Question Title

* 9. If you answered YES to question 6 or 7, please provide your name and preferred contact below

Name

Email Address

Phone Number

Question Title

* 10. If you would like to go in the monthly draw to win a box of premium Who Gives a Crap toilet paper valued at $60 please include a contact number here if you haven't completed Q9