FEC Form 1 for SOCIETY OF INTERVENTIONAL RADIOLOGY POLITICAL ACTION COMMITTEEForm 1 for SOCIETY OF INTERVENTIONAL RADIOLOGY POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-367787

1. SOCIETY OF INTERVENTIONAL RADIOLOGY POLITICAL ACTION COMMITTEE

3975 Fair Ridge Dr.
Suite 400 North
FAIRFAX, VA 22033
Fax: 7036911855
Email: dhuynh@sirweb.org

2. Date: 10/14/2008

3. FEC Committee ID #: C00408435 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Society of Interventional Radiology
3975 Fair Ridge Drive, Ste 400 N
Fairfax, Virginia 22033
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jeff Nielsen
3975 Fair Ridge Drive, Ste 400 N
Fairfax, VA 22033
Title: Accounting Manager
Phone # (703) 691-1805

Treasurer:

Doug Huynh
3975 Fair Ridge Drive, Ste 400 N
Fairfax, Virginia 22033
Title: PAC Manager
Phone # (703) 691-1805

Designated Agent(s):

Jeff Nielsen
3975 Fair Ridge Drive, Ste 400 N
Fairfax, Virginia 22033
Title: Accounting Manager
Phone # (703) 691-1805

Banks or Depositories

Bank of America
PO Box 27025
Richmond, Virginia 23261

Signed: Doug Huynh
Date Signed: 10/14/2008
Official Committee URL: www.sirweb.org
Official Committee FAX: 7036911855

(End FEC FORM 1)

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