Time to Take ADVANTAGE!
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 mail in the application
on this page.
Sign Me Up!
Please provide all information requested below for
individuals or couples. Payment must accompany this
application. Allow four to five weeks for processing.
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.
Yearly Membership Fee: $15 Single $25 Couple
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 |
