FEC Form 1 for AMERICAN MEDICAL ASSOCIATION POLITICAL ACTION COMMITTEEForm 1 for AMERICAN MEDICAL ASSOCIATION POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-95968

1. AMERICAN MEDICAL ASSOCIATION POLITICAL ACTION COMMITTEE

1101 VERMONT AVENUE NW
12TH FLOOR
WASHINGTON, DC 20005
Fax: 2027897469
Email: EVA_PETTY@AMA-ASSN.ORG

2. Date: 09/24/2003

3. FEC Committee ID #: C00000422 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

KEVIN WALKER
1101 VERMONT AVENUE NW
12 FLOOR
WASHINGTON, DC 20005
Title: TREASURER
Phone # (202) 789-7467

Designated Agent(s):

MICHAEL CYS
1101 VERMONT AVENUE NW
12TH FLOOR
WASHINGTON, DC 20005
Title: ASSISTANT TREASURER
Phone # (202) 789-7457

DAVID SELBY MD
3 ROLLING OAKS
ENID, Oklahoma 73703
Title: SECRETARY
Phone # (580) 233-1090

JOHN LEARY
1101 VERMONT AVENUE NW
12 FLOOR
WASHINGTON, DC 20005
Title: ASSISTANT TREASURER
Phone # (202) 789-7433

Banks or Depositories

Signed: KEVIN WALKER
Date Signed: 09/24/2003
Official Committee URL: AMPACONLINE.ORG
Official Committee FAX: 2027897469

(End FEC FORM 1)

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