This Agreement (this “Agreement”) is made between {Legal Entity Name:1}, a {Entity Type:3} organized and existing under the laws of the State of {State of Organization:4} with its principal place of business at {Address:5} and a Federal Tax I.D. number of {Federal Tax ID:6} (collectively the “Member”) and Entheos Audiology Cooperative, Inc., an Indiana Cooperative with its principal office located at 418 W Baker St, Fort Wayne, Indiana 46802 (the “Cooperative”) (collectively referred to as the “Parties”).

This Agreement is entered into as of {date_mdy}.

The Member agrees to comply with the policies, procedures, participation requirements, and operational guidelines established by Entheos Audiology Cooperative, Inc. Membership benefits, programs, and participation opportunities are subject to Cooperative rules and eligibility requirements as established and updated from time to time.

The Cooperative agrees to provide the Member with access to available membership resources, programs, services, educational opportunities, and other benefits associated with participation in the Cooperative.

This Agreement represents the understanding between the Parties and may be supplemented by additional written policies, procedures, or membership documentation provided by the Cooperative.

By submitting this Agreement, the Member acknowledges that the information provided is accurate and that the individual completing this form is authorized to act on behalf of the Member entity.