Port Washington
Application

Membership Application – Department

Please complete all required fields. We'll contact you after review.
Address: 423 Port Washington Boulevard Port Washington, New York 11050
Phone: 516-883-2200
Date
September 19, 2026
Initials
 
Reviewed by
 
Applicant Information
As it appears on your ID.
 
We'll send confirmation here.
Mobile preferred.
Primary residence.
You must be at least 16 years old to apply.
Background
Optional, but helpful.
Statement of Interest
Signature (E-Sign)
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