Max Wilkinson’s Brexit survey

If you return this survey, the Liberal Democrats, locally and nationally, may use information provided, including your political views, to further our objectives, share it with our elected representatives and/or contact you in future using any of the means provided. Some contacts may be automated. You may opt out of some or all contacts or exercise your other legal rights by contacting us. Further details are in our Privacy Policy at www.libdems.org.uk/privacy.

1. Your contact details *

First Name	*
Last Name	*
Postcode	*
Email	*

2. How did you vote in the EU Referendum?

3. How will Brexit impact on Britain?

	Positive	Negative
Do you think Brexit will have a positive or negative effect on the economy?	Do you think Brexit will have a positive or negative effect on the economy? Positive	Do you think Brexit will have a positive or negative effect on the economy? Negative
Do you think Brexit will have a positive or negative effect on your family's future?	Do you think Brexit will have a positive or negative effect on your family's future? Positive	Do you think Brexit will have a positive or negative effect on your family's future? Negative
Do you think Brexit will have a positive or negative effect on immigration?	Do you think Brexit will have a positive or negative effect on immigration? Positive	Do you think Brexit will have a positive or negative effect on immigration? Negative
Do you think Brexit will have a positive or negative effect on local jobs?	Do you think Brexit will have a positive or negative effect on local jobs? Positive	Do you think Brexit will have a positive or negative effect on local jobs? Negative
Do you think Brexit will have a positive or negative effect on the NHS?	Do you think Brexit will have a positive or negative effect on the NHS? Positive	Do you think Brexit will have a positive or negative effect on the NHS? Negative

4. On a scale of 1 to 5 (with 1 meaning ‘not at all’), how closely do the following political parties currently represent your views?

	1	2	3	4	5
Liberal Democrat	Liberal Democrat 1	Liberal Democrat 2	Liberal Democrat 3	Liberal Democrat 4	Liberal Democrat 5
Conservative	Conservative 1	Conservative 2	Conservative 3	Conservative 4	Conservative 5
Labour	Labour 1	Labour 2	Labour 3	Labour 4	Labour 5
Green	Green 1	Green 2	Green 3	Green 4	Green 5
UKIP	UKIP 1	UKIP 2	UKIP 3	UKIP 4	UKIP 5