Senior Advantage Program Application Form

Senior AdvantagePlease mail completed form and your payment to:

Senior Advantage Program
Manatee Healthcare System
206 Second Street East
Bradenton, FL 34208

Questions? Call our office at (941) 745-7548.
Please allow 3-4 weeks for processsing.
Thank you for joining Senior Advantage!


Manatee Healthcare System
Senior Advantage Program Application Form


Applicant's Name:_________________________________________ Date of Birth_______________

Co-Applicant's Name:_______________________________________ Date of Birth_______________

Address: _________________________________________________________________________

City: ___________________________________________/State____________/Zip______________

Telephone: ______________________________/ Email:____________________________________

Are you a Veteran? ____ yes ____ no Co-applicant? ____ yes ____ no

How did you hear about Senior Advantage? _____________________________________________

Method of Payment: Annual cost is $15.00 single/$25.00 per couple. OR Lifetime cost $45.00 single/ $70.00 per couple.

___ Check (Make checks payable to "MHS Senior Advantage")

___ Credit Card (We will contact you for credit card information by telephone when application is received.)

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Manatee Memorial Hospital is owned and operated by a subsidiary of Universal Health Services, Inc. (UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.     

Manatee Memorial Hospital
206 Second Street East
Bradenton, FL 34208

© 2014 Manatee Memorial Hospital. All rights reserved.

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