Ben Gould Issues Survey
Email address *
What three issues are most important to you at the local City Council level? *
Required
What do you think should be done about these issues?
Your answer
What else do you want Ben to know?
Your answer
The following information is optional, but requested:
First Name
Your answer
Last Name
Your answer
Phone #
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Ben Gould.