PARTICIPATION AGREEMENTParticipation Agreement • January 8th, 2015
Contract Type FiledJanuary 8th, 2015THIS AGREEMENT is entered into effective the day of , 20__, by and between (a) THE ANESTHESIA QUALITY INSTITUTE, an Illinois not-for-profit corporation with its principal place of business at 1601 American Ln, Schaumburg, IL 60173 (“AQI”); and (b)_____________________________________, a group of anesthesiologists or healthcare facility whose principal place of business is at ______________________________ (“Participant”).