First Responders, Active Military and Veterans Membership Application Form

Please provide the following information to apply for your free First Responders, Active Military and Veterans Membership.

We will process your free membership for you and send confirmation directly to your email address.

If you would prefer not to provide the required information via this tool, feel free to send it in an email to info@sagharborcinema.org, or provide in person at the box office.

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Name Proof Number

Email *

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Customer Account Number

If you already have a customer account with Sag Harbor Cinema and know your account number, provide it here.

Upload Proof *

Click or drag a file to this area to upload.

Please provide photo proof of being part of any Suffolk County EMT, Police Department, Fire Department, Rescue Squad; qualification as an Emergency Medical Professional; or Active Military or Veteran ID.

Submit