* 1. Name

* 2. Address

* 3. Email address

* 4. What is the main local issue facing your neighbourhood right now?

* 5. What is the main issue facing the country right now?

* 6. Did you support Steve Brine MP in the 2015 General Election?

* 7. If you would like to explore any issues with Steve, please write below, and also email steve.brine.mp@parliament.uk for a fast response.

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