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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-46916

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1. American Academy of Otolaryngology - Head and Neck Surger

    One Prince Street
    Alexandria, VA 223143357

2. Date: 08/15/2002

3. FEC Committee ID #: C00306449 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

MD David Nielsen
, ____
Title: Treasurer
Phone # (703) 836-4444

Designated Agent(s):

Banks or Depositories

Signed: MD David Nielsen
Date Signed: 08/15/2002

(End FEC FORM 1)

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