FEC Form 1 for PHYSICIANS FOR WOMEN'S HEALTH PACForm 1 for PHYSICIANS FOR WOMEN'S HEALTH PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-121657

1. PHYSICIANS FOR WOMEN'S HEALTH PAC

409 12TH STREET SW
WASHINGTON, DC 20024

2. Date: 05/28/2004

3. FEC Committee ID #: C00364158 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Committee ID# C00364158
PHYSICIANS FOR WOMEN'S HEALTH PAC
409 12TH STREET SW
WASHINGTON, DC 20024
Relationship: CONNECTED
Organization Type: Membership Organization

Custodian of Records:

SARA SLANE
409 12TH STREET SW
WASHINGTON, DC 20024
Title: TREASURER
Phone # (202) 863-2505

Treasurer:

SARA SLANE
409 12TH STREET SW
WASHINGTON, DC 20024
Title: TREASURER
Phone # (202) 863-2505

Designated Agent(s):

Banks or Depositories

SUNTRUST BANK
1445 NEW YORK AVENUE NW
WASHINGTON, DC 20005

Signed: SARA SLANE
Date Signed: 06/02/2004

(End FEC FORM 1)

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