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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-52544

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1. AMERICAN CHIROPRACTIC ASSOCIATION POLITICAL ACTION COMMITTEE

    1701 CLARENDON BOULEVARD
    .
    ARLINGTON, VA 22209

2. Date: 10/09/2002

3. FEC Committee ID #: C00102764 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Dr. Michael Perusich
3405 W 10th Street
Sedalia, Missouri 65301
Title: Treasurer
Phone # (660) 829-2600

Designated Agent(s):

Banks or Depositories

Signed: Dr. Michael Perusich
Date Signed: 10/09/2002

(End FEC FORM 1)

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