	THE SOUTH COMMUNITY ASSEMBLY SURVEY

	SURVEY ADMINISTRATION PAGE

1.	Enter the South team Identification Code This code will be given to you by a member of the team when you are invited to complete this survey. Forms containing an unrecognised code will be disregarded.

2.	Please enter your Post Code. (postcode must be entered in order for us to monitor which community you live in)

THIS SURVEY IS ANONYMOUS - but you may (if you wish) write in any of the boxes below if you would like the Council to know who you are.
(if you enter your details, you will be entered into a free prize draw for £50 meadowhall gift vouchers)

Enter Your Name
Enter Your Address
Enter your Neighbourhood/Ward area
Enter Your Telephone no.
Enter Your E-Mail address

Please tick how the Community Assembly team should contact you. You will need to enter your contact details in the question above.

		tick
I would like to receive regular updates by email
I would like to receive regular updates by post
I would like feedback on my issue which I will raise in this survey - by email
I would like feedback on my issue which I will raise in the survey - by post
I DO NOT wish to be contacted
I wish to remain Anonymous

5.	Please tell us if you are involved in any Community Organisation(s).