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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-455329

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1. American Chiropractic Association PAC

    1701 Clarendon Blvd
    Arlington, VA 22209
    Email: acapac@acatoday.com

2. Date: 03/12/2010

3. FEC Committee ID #: C00102764 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

American Chiropractic Association
1701 Clarendon Blvd
Arlington, Virginia 22209

Custodian of Records:

Treasurer:

Dr Michael Simone
1701 Clarendon Blvd
Arlington, Virginia 22209
Phone # (703) 276-8800

Designated Agent(s):

Emory Rogers
1701 Clarendon Blvd
Arlington, Virginia 22209
Title: PAC Manager
Phone # (703) 812-0228

Banks or Depositories

BB&T
Arlington, Virginia 22209

Signed: Dr Michael Simone
Date Signed: 03/12/2010

FORM TEXT

(End FEC FORM 1)

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