FEC Form 1 for American Optometric Association Political Action CommitteeForm 1 for American Optometric Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1178582

1. American Optometric Association Political Action Committee

1505 Prince Street
Suite 300
Alexandria, VA 22314
Email: MKallupura@aoa.org,DFKuny@aoa.org

2. Date: 08/10/2017

3. FEC Committee ID #: C00024968 This committee is a separate segregated fund. Its connected organization is a Membership Organization
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

American Optometric Association
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Steven Nguyen, O.D.
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Title: Treasurer AOA-PAC
Phone # (703) 837-1345

Designated Agent(s):

Meera Kallupura
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Title: Asst Dir, Pol Aff
Phone # (703) 837-1376

Meera Kallupura
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Title: asst Dir Pol Aff
Phone # (703) 837-1376

Banks or Depositories

Bank of America
P O Box 798
Wichita, Kansas 67201

Wachovia Bank
P O Box 563966
Charlotte, North Carolina 282563966

United Bank
1801 Reston Parkway
Reston, Virginia 20190

Signed: Steven Nguyen, O.D.
Date Signed: 07/18/2017

FORM TEXT-1

(End FEC FORM 1)

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