www.karenjohnsonforcongress.com Karen Johnson for Congress - Information Gathering Question Title * 1. When you heard that I was running for the U.S. Congress, what was your first reaction? I'll vote for you (if I'm in your District (IL-3))! Great! We need someone like you in Congress! Why? Tell me more Other (please specify) Question Title * 2. What would you most like to know about me or my candidacy to know if you would support me as a vote, volunteer or advocate? Most important Very important Less important Least important Your voting record for local and national representatives Your voting record for local and national representatives Most important Your voting record for local and national representatives Very important Your voting record for local and national representatives Less important Your voting record for local and national representatives Least important How you stand on one or more issues How you stand on one or more issues Most important How you stand on one or more issues Very important How you stand on one or more issues Less important How you stand on one or more issues Least important Your vision for your relationship with voters Your vision for your relationship with voters Most important Your vision for your relationship with voters Very important Your vision for your relationship with voters Less important Your vision for your relationship with voters Least important What you hope to accomplish while in office What you hope to accomplish while in office Most important What you hope to accomplish while in office Very important What you hope to accomplish while in office Less important What you hope to accomplish while in office Least important Other (please specify) Question Title * 3. If, after a thorough evaluation of all candidates, you thought I was the best choice as your Congressperson (whether or not you are in my district for the sake of this question), would you vote for me as an Independent? Yes No Not sure Question Title * 4. Are you registered to vote in Illinois' 3rd Congressional District (or will be before 11/4/14? Yes No Question Title * 5. Generally speaking, do you usually think of yourself as a Republican, a Democrat, an Independent, or something else? Republican Democrat Independent Something else Question Title * 6. If you think of yourself as a Democrat, would you call yourself a strong Democrat or a not very strong Democrat? Strong Not very strong I do not think of myself as a Democrat Question Title * 7. If you think of yourself as a Republican, would you call yourself a strong Republican or a not very strong Republican? Strong Not very strong I do not think of myself as a Republican Question Title * 8. If you think of yourself as an Independent, do you think of yourself as more similar to Republicans than Democrats, more similar to Democrats than Republicans, or equally similar to Republicans and Democrats? More similar to Republicans than Democrats More similar to Democrats than Republicans Equally similar to Republicans and Democrats I do not think of myself as an Independent Question Title * 9. If you think of yourself as an Independent, do you think of yourself as closer to the Republican Party or to the Democratic Party, or equally close to the Republican Party and Democratic Party? The Republican Party The Democratic Party Equally close to the Republican Party and Democratic Party I do not think of myself as an Independent Question Title * 10. Are you currently registered to vote in the state where you live now, or are you not registered to vote there? Registered in state where I live Not registered in state where I live Not registered Question Title * 11. When you registered to vote in the state where you live now, did you say on the form that you are a Republican, a Democrat, or neither a Republican nor a Democrat? Republican Democrat Neither Question Title * 12. Did you vote in one or more elections run by the U.S. government during the last ten years, or did you NOT vote in any elections run by the government during the last ten years? Did vote Did not vote Question Title * 13. Of all the political candidates you voted for during the last 10 years, what percent of them were Republicans, what percent were Democrats, what percent were Independents, and what percent were something else? (Your answers should add up to 100%.) Percent Republicans Percent Democrats Percent Independents Percent something else Question Title * 14. Please indicate your interest level in learning more about my campaign or thoughts about changing our relationships with our Members of Congress. Very interested - I am going to KarenJohnsonforCongress.com immediately to learn more Somewhat interested - Please place me on your mailing list (or I will do so separately) Not interested Not sure - Put me on your list and I'll notify you if I'd like to be moved Other or Comments (please specify) Question Title * 15. Please honor my confidentiality choice below. I wish to remain anonymous for this survey. Feel free to contact me about anything I've offered above. Place me on your email list, but please do not contact me personally. Other (please specify) Question Title * 16. Contact information (optional) Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Question Title * 17. Any additional thoughts or questions? Done