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Lobbying Feedback Form

Now that you have completed your visit or contact with your Local Member of Parliament, or other politician, please let ChilOut know how this went. We will use this information to keep track of which MPs and politicians have been contacted, which have not, and of the views or positions of the politicians you contact.

Your Given Name: Family Name:
Your Phone Number: Your Email Address:
Type of Contact: Date (DD/MM/YY):
Details of your MP or other politician you have contacted:
MP Given Name: Family Name:
Federal/State: Party:
Federal Electorate: or enter below  
Senate Seat / State Electorate / Other:  
What major issue(s) did you raise and how did they respond?
Issue raised 1:
Response:  
Issue raised 2:
Response:
Issue raised 3:
Response:  
Other Comments:

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