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Only fields marked with an asterix are required for registration, but filling out the rest of the form will help us cater for you better.

Individual Details:

Step 1

Please provide your personal details.

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First name*
Last name*
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Position

Postal Address:

Step 2

So we can contact you by post please provide your address.
Preferred Contact Method
House/Flat Number
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e-Mail & Mobile:

Step 3

To receive important emails and text messages please let us know your details below.

e-Mail*
Telephone (work)
Telephone (home)
Mobile no
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Categories:

Step 4

Choose the areas you are interested in from the list below.


Support	Select all
Addictions	Advocacy
Bereavement Care & Counselling	Counselling
Mediation	Offenders/Ex-Offenders
Relationship Counselling	Victims of Crime
Witness Support
Community	Select all
Community Development	Community Centres/Halls
Community Facilities	Councillors/MPs/MEPs
Crime & Safety	Faith Groups
Local Council	Media & Publicity Contacts
Places of Worship	Support for Community Groups

Health & Disability	Select all
Specific Health Conditions	Learning Disabilites
Local NHS Health Services	Mental Health
Physical Disabilities	Sensory & Communication Disabilities

Advice & Information	Select all
Citizen's Advice	Advocacy
Benefit/Debt/Welfare Rights	Domestic Violence
Funding Advice	Practical Support
Volunteering Advice
Training & Work	Select all
Return to Work Support	Business Support
Education	Volunteering

Arts, Entertainment, Leisure and Sports	Select all
Creative Arts	Befriending Services
Dance	Heritage & Local History
Local Speakers	Music & Choral
Parks & Open Spaces	Social Clubs
Sports & Physical Activities	Theatre

Children & Young People	Select all
Child Care	Junior Clubs
Out of School Care	Parent & Child Contact Centres
Parent & Toddler Groups	Parent Support
Preschools	Youth Clubs

Housing	Select all
Tenants & Residents Associations	Care Homes
Home Improvement	Homelessness
Housing Associations	Sheltered Housing
Supported Housing
Environment	Select all
Conservation/Environment/Recycling	Campaigners
Community Transport	Emergency Services
Gardening Schemes	Local History & Heritage
Neighbourhood Watch	Volunteer Drivers/Cars

Client Groups	Select all
Black/Ethnic Minority	Carers
Children	Lesbian/Gay/Bisexual/Transgender
Older People	People with Disabilities
People with Learning Disabilities	People with Mental Health Issues
People with Specific Health Conditions	Young People

Animals	Select all
Animal Rescue	Animal Clubs & Societies

Older People	Select all
Luncheon Clubs	Advocacy
Care Homes	Friendship Clubs
Good Neighbour Schemes	Health
Transport
Geographical Areas Location	Select all
Wards (as listed to the right)	Belfairs
Blenheim Park	Chalkwell
Eastwood Park	Essex Southend & Thurrock
Kursaal	Leigh
Milton	National
New Essex	Prittlewell
Shoeburyness	South East Essex
South Essex	Southchurch
Southend & surrounding areas	Southend, Rochford & Castle Point
Southend-on-Sea Borough	St Laurence
St Lukes	Thames Gateway
Thorpe	Victoria
West Leigh	West Shoebury
Westborough
Geographical Areas Served	Select all
Wards (as listed to the right)	Belfairs
Blenheim Park	Chalkwell
Eastwood Park	Essex Southend & Thurrock
Kursaal	Leigh
Milton	National
New Essex	Prittlewell
Shoeburyness	South East Essex
South Essex	Southchurch
Southend & surrounding areas	Southend, Rochford & Castle Point
Southend-on-Sea Borough	St Laurence
St Lukes	Thames Gateway
Thorpe	Victoria
West Leigh	West Shoebury
Westborough

Login details:

Step 5

You need to think up a username and password for yourself. This will enable you to access further areas on our web site (password can be changed later). Your username must be at least 6 characters long with no spaces.

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Access to computer facilities:

Step 6

Please answer the following questions.

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Public Sector:

Step 7

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Step 8

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