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FEC Form 1 for SOCIETY FOR VASCULAR SURGERY POLITICAL ACTION COMMITTEEForm 1 for SOCIETY FOR VASCULAR SURGERY POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-125678

1. SOCIETY FOR VASCULAR SURGERY POLITICAL ACTION COMMITTEE

    633 N. St. Clair St.
    24th Floor
    Chicago, IL 60611

    NOTE: Address is different than previously reported

    Fax: 3122025007

2. Date: 07/13/2004

3. FEC Committee ID #: C00381459 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Society for Vascular Surgery
633 N. St. Clair St.
24th Floor
Chicago, Illinois 60611
Relationship: Connected
Organization Type: Trade Association

Custodian of Records:

Rebecca Maron
633 N. St. Clair St.
24th Floor
Chicago, IL 60611
Title: Executive Director
Phone # (312) 202-5601

Treasurer:

Dr. Robert Zwolak
359 Dogford Road
Etna, New Hampshire 03750
Title: Treasurer
Phone # (603) 650-4682

Designated Agent(s):

Rebecca Maron
633 N. St. Clair St.
24th Floor
Chicago, Illinois 60611
Title: Executive Director
Phone # (312) 202-5601

Banks or Depositories

Bank One
111 E. Busse Ave.
Mt. Prospect, Illinois 60056

Signed: Dr. Robert Zwolak
Date Signed: 07/13/2004
Official Committee FAX: 3122025007

(End FEC FORM 1)


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