This survey is for the Newlands and Savannah residents to enable your representative to serve you better and keep you informed on all our community activities. We would appreciate all residents over 18 completing it. Please note that this information will not be shared with any outside entities and will be used strictly for the improvement of our communities. Thank you!

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1. First Name (Required.)

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2. Last Name (Required.)

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3. Constituency  (Required.)

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4. Home Phone #

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5. Mobile Phone #

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6. Date of Birth 

Date

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7. P.O. Box 

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8. KY1-

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9. Street Address (Required.)

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10. Email  (Required.)

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11. Are you currently employed? (Required.)

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12. Employer

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13. Are you currently looking for work?

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14. If you are unemployed, please tell us what qualifications or experience you have.

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15. How many children are you parent or guardian for and live in your household (aged 17 or younger only)? (Required.)

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16. Please provide NAME, AGE and DATE OF BIRTH for all children in the house 17 and under.

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17. Would you like to receive community newsletters via email? (Required.)

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