Please rate the following issues in the priority order of concern and interest to you on a scale of 1-10. Before rating, please take the time to carefully read each issue and the note of identification for that issue.

Economics:

• Education 1 2 3 4 5 6 7 8 9 10
• Alimony 1 2 3 4 5 6 7 8 9 10
• Aide To Families With Dependent Children 1 2 3 4 5 6 7 8 9 10
• Child Support 1 2 3 4 5 6 7 8 9 10
• Women In Economic Development 1 2 3 4 5 6 7 8 9 10
  (Including pay equity, job training, and business ownership)

Equity:

• Racial and Gender Equity On Corporate Boards and Commissions 1 2 3 4 5 6 7 8 9 10
• Racial and Gender Equity in Public Schools 1 2 3 4 5 6 7 8 9 10

Health:

• Adolescent Pregnancy 1 2 3 4 5 6 7 8 9 10
• Health Insurance Access to HIV-AIDS and Other Sexually Transmitted Diseases 1 2 3 4 5 6 7 8 9 10
• Aide To Families With Dependent Children 1 2 3 4 5 6 7 8 9 10
• Older Women 1 2 3 4 5 6 7 8 9 10
• Reproductive Care 1 2 3 4 5 6 7 8 9 10
• Substance Abuse 1 2 3 4 5 6 7 8 9 10

Employment:

• Child Care 1 2 3 4 5 6 7 8 9 10
• Employment Discrimination 1 2 3 4 5 6 7 8 9 10
• Family and Medical Leave 1 2 3 4 5 6 7 8 9 10
• Pay Equity 1 2 3 4 5 6 7 8 9 10
• Sexual Harassment 1 2 3 4 5 6 7 8 9 10
• Workplace Health and Safety 1 2 3 4 5 6 7 8 9 10
  

Violence Against Women:

• Battering Syndrome 1 2 3 4 5 6 7 8 9 10
• Domestic Violence 1 2 3 4 5 6 7 8 9 10
• Sexual Assault 1 2 3 4 5 6 7 8 9 10
  

Last name:				City:
Middle name:				Prov./State:
First name:				Country:

Tel:(day)

Night:

Email

Fax:

Congressional District