Application

To become a member of the Esher & District Citizens Advice Bureau you must:

• Be 18 years of age or older
• Live or work in the Borough of Elmbridge
• Be willing to pay an annual Membership fee of £5 (anyone receiving means-tested benefits is exempt from this fee)

Please indicate that you meet these requirements by providing the following information:

Full Name

Home Address (if you live in the Borough of Elmbridge)

Home Postcode

Work Address (if you do NOT live in the Borough of Elmbridge)

Work Postcode

I confirm that I am 18 years old or older

I confirm

I am on means-tested benefit and so exempt from the Membership Fee I am willing to pay the five pound annual membership fee.

Your e-mail address