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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-104504

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1. INDOOR TANNING ASSOCIATION PAC

    6620 Fletcher Lane
    McLean, VA 22101

    NOTE: Address is different than previously reported

2. Date: 01/23/2004

3. FEC Committee ID #: C00362020 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Indoor Tanning Association Inc.
PO BOX 4001
Jackson, Michigan 49201
Relationship: Connected Org
Organization Type: Trade Association

Custodian of Records:

John Overstreet
6620 Fletcher Lane
McLean, VA 22101
Title: Treasurer/Custodian
Phone # (703) 288-0078

Treasurer:

John Overstreet
6620 Fletcher Lane
McLean, Virginia 22101
Title: Treasurer
Phone # (703) 288-0078

Designated Agent(s):

Banks or Depositories

Virginia Commerce Bank
5350 Lee Highway
Arlington, Virginia 22207

Signed: John Overstreet
Date Signed: 01/23/2004

(End FEC FORM 1)

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