I am interested in your opinion, even if you don't agree with what I have to say, or like my children in the photo above, who would rather be watching Barney. Your opinion will remain confidential and I will NOT give any identifying information from this form to any third-party or political organization (unless you are threatening - so anybody who is crazy best not submit this form).
   

What do you think of my views?

(Bertman is a moron) 1 2 3 4 5 (Bertman is Right On!)
 
What Issue(s) are you most concerned about?
 
Tell me how you would change things?
 

Where do you fall on the balance between town services and the money to pay for them (e.g., taxes)?

(Fewer services = lower taxes) 1 2 3 4 5 (More services = higher tax)

For this question assume, each dollar is spent carefully and with a minimum on administration cost.
 

What else do you want to tell me?

 

Your Gender

Male Female
 

Your Age

years old
 

How did you hear about me?

 

Your Email Address

 
Please check this box if you wish to receive occasional updates from me. I will not give or sell your email address to anybody else, including political organizations (I hate spam too)!
 

Phone Number?

Willing to donate some time to the campaign? If so, please give me a number where I can reach you. Thanks!