At Worcestershire County Council we think that it is really important to keep residents informed about our services. Help us to provide information in the right way by completing our short survey by 28th November 2008 and you will be entered into a prize draw to win a digital radio.

Terms and Conditions: The decision of Worcestershire County Council is final and no correspondence will be entered into. No cash alternative will be offered. Entries must be received no later that 28 November 2008. Only one entry per person. Only the prize winner will be contacted. If you have any questions about this prize draw call 01905 766641 or email commsunit@worcestershire.gov.uk

Data Protection: The Data Controller of your personal data is Worcestershire County Council. The personal data you provide to us will be used to administer the prize draw, and to contact you about future events, services and consultations if you state in the questionnaire below that you are happy for us to do so.

What newspapers do you read? Please list

What radio stations do you listen to? Please list

How would you prefer to receive information about our events, services or consultations? Please select ALL that apply
Direct Mail		Events
Look on our website		Email
Local papers		Other

If Other, please specify

Are you happy to be contacted by us about events, services or consultations that may be of interest to you?

Yes

No

Contact details: Please note that contact details must be supplied in order to notify the winner of the prize draw

Name

Address

Postcode

Telephone number

Email Address

Please tick what describes your ethnicity best:
White - British		Black
White - Other		Chinese
Asian		Other

If other, please specify

Thank you for filling in this questionnaire, please click SUBMIT below to complete the process