Student Membership Application

Please provide the following information to apply for your Student Membership. Once your application is processed, we will send a payment request 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.

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Name *

First

Last

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 *

Address Number Customer

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 upload a photo or scan of your valid student ID.

Submit