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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-262596

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1. Arizona Orthopaedic Society Politial Action Committee

    810 West Bethany Home Road
    Phoenix, AZ 85013
    Email: patriceh@azmedassn.org

2. Date: 12/06/2006

3. FEC Committee ID #: C00279836 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

David Ott
333 W. Thomas Rd. A
Phoenix, AZ 85013

Treasurer:

David Ott
333 W. Thomas Rd. A
Phoenix, Arizona 85013

Designated Agent(s):

Banks or Depositories

Signed: David Ott
Date Signed: 12/06/2006

(End FEC FORM 1)

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