FEC Form 1 for AMERICAN SOCIETY FOR CLINICAL LABORATORY SCIENCE POLITICAL ACTION COMMITTEE (FKA ASMT/PAC)Form 1 for AMERICAN SOCIETY FOR CLINICAL LABORATORY SCIENCE POLITICAL ACTION COMMITTEE (FKA ASMT/PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1021851

1. AMERICAN SOCIETY FOR CLINICAL LABORATORY SCIENCE POLITICAL ACTION COMMITTEE (FKA ASMT/PAC)

1861 International Drive
#200
Tysons Corner, VA 22102
Email: elissap@ascls.org

2. Date: 08/17/2015

3. FEC Committee ID #: C00034645 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

American Society for Clinical Laboratory Science
1861 International Drive
#200
Tysons Corner, Virginia 22102
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Diane Evans
PO Box 75357
Washington, DC 20002
Title: Treasurer
Phone # (202) 548-0880

Treasurer:

Diane Evans
PO Box 75357
Washington, DC 20002
Title: Treasurer
Phone # (202) 548-0880

Designated Agent(s):

Debra Shell
5812 West Buckskin Rd
Pocatello, Idaho 83201
Title: Assistant Treasurer
Phone # (208) 234-0722

Banks or Depositories

PNC Bank
1799 Columbia Rd NW
Wahsington, DC 20009

Santander Bank
PO Box 961245
Fort Worth, Texas 76161

Signed: Diane Evans
Date Signed: 08/18/2015

(End FEC FORM 1)

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