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.

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

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How did you hear about the Scheme?

Email Address
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Condom Demonstration
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Data Protection

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Resident of Borough *
Mobile Number