FEC Form 1 for American Association of Oral and Maxillofacial Surgeons Political Action CommitteeForm 1 for American Association of Oral and Maxillofacial Surgeons Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-27467

1. American Association of Oral and Maxillofacial Surgeons Political Action Committee

9700 West Bryn Mawr Ave.
Rosemont, IL 60018

2. Date: 02/19/2002

3. FEC Committee ID #: C00005660 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Dr. Terry Cisler
1602 N. Randall Ave.
Janesville, Wisconsin 53545
Title: Treasurer
Phone # (608) 756-8744

Designated Agent(s):

Banks or Depositories

Signed: Dr. Terry Cisler
Date Signed: 02/19/2002

(End FEC FORM 1)

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