Time to Take ADVANTAGE!

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

You also will receive informative health literature and physician referrals, and you can take advantage of special events, health fairs, seminars, exercise classes and screenings.

If you are a patient in the hospital, the benefits of the Senior Advantage Program are even greater, including the possible waiver of the Part A Medicare deductible for members age 65 and older.

For more information, please call 941-745-7548 or print out and mail in the application on this page.

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 four to five 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?	Today's Date:
Yes No
Make checks payable to Senior Advantage Program. Mail to: Senior Advantage Program Manatee Memorial Hospital 206 Second Street East Bradenton, Florida 34208

206 Second Street East, Bradenton, FL 34208 941-746-5111 FAX: 941-745-6862