Thanks to the Senior Advantage Program at Manatee Memorial Hospital, those of you 50 and over can receive free and discounted services that will enhance your health and well-being, even if you do not spend time in the hospital.

You also will be linked with services that include informative health literature, physician referrals, special events, health fairs, seminars, exercise classes and screenings.

If you must visit the hospital, the benefits of the Senior Advantage Program are even greater, including possibly waiving the Part A Medicare deductible for members age 65 and older.

For more information, call 941-745-7548 or mail in the application below.

APPLICATION
Sign Me Up!
Yearly Membership Fee: $15 Single $25 Couple
Please provide all information requested below for individuals or couples. Payment must accompany this application. Allow 4-5 weeks for processing.

Applicant's Name (Please Print):		Birthdate (mo/day/yr):
Co-applicant's Name:		Birthdate (mo/day/yr):
Applicant's Signature:
Co-applicant's Signature:
Address:
City:		State:	ZIP:
Telephone (home):		Telephone (work):
Applicant's Social Security Number:		Co-applicant's Social Security Number:
Applicant's Medicare Number:		Co-applicant's Medicare Number:
Applicant's Physician(s):		Co-applicant's Physician(s):
Supplemental Insurance Provider:		No Insurance
Address of Insurance Provider:
Policy Number:
Are you a veteran? Yes No		Today's Date:
Make checks payable to Senior Advantage Program. Mail to: Senior Advantage Program Manatee Memorial Hospital 206 Second Street East Bradenton, Florida 34208