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 Sign Me Up!
Yearly Membership Fee: $15 Single, $25 Couple
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.
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 |
