southend

Free Condoms Southend.

Online registration is only available if you are 16 or over and live in Southend on Sea.

If you are under 16, you can register for a c-card by visiting your nearest registering Condom Distribution Service outlet. Click here to find an outlet near you.

If you are 16 or over, you also have the option to register online.

To register online, all you need to do is fill out your details below and we will email you with the information you need to complete your registration.  You will then be able to pick up free condoms at any participating Condom Distribution Service outlet.

All information is confidential and we will not store your postcode or email address, these will be deleted as soon as your registration is complete.

 

 

about you

Please complete all the required fields below. Any blue fields are optional.

Outlet Code
Initial  & Surname
 
Date Of Birth
/ /
Gender
Ethnic Background
Sexual Orientation
Postcode

Please enter Postcode and click 'Lookup'.

Why we ask for your postcode? (show)

How did you hear about the Scheme?

Email Address
Confirm Email Address
Condom Demonstration
Please tick to confirm you have watched the Condom Demonstration.
Data Protection

Show Statement



Resident of Borough *
Mobile Number