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a <br />APPLICATI0�1 FOR ADVISpRY G�OQPS : <br />Group Applied For: � <br />� cc� �/ or"� � c 1�'' 1/,ic� o <br />Second Choice (if any): <br />�Full Name (print or tyoe): <br />0 <br />-,✓; �c��� �r7 � SS , o.-� <br />� T <br />o,J q �,� / c�l �h i� <br />Address : � /�.yo G)�.4 �'t LA /✓b �� �Nl.1S �in/ <br />��.� � <br />,Years At This Address: Xears Xou Eiave Lived Tn Mounds View: _ <br />' l7 �7 <br />ITelephone: Eiome: _ sJ�B t�7or:t o� Othe�: <br />7�'-� 7,8�= l %7g ' <br />QUALTEIC3TIONS YOU WANT TO HAVE THE COUNCIL C0�ISIDER <br />ISkills and Interests: <br />�:nployment, Occupation or other Ex�erienc�: �1 ,��] <br />� v �l� Oco �G�n /7���/��" ° �t��cC <br />(��,/C,Z �,= I�► o JiJ 1�S I/cW <br />� f ASi I�hAr�A G�i�ii�� �T ��c Y��"�.E�✓ c,� , <br />;�iembersni�s, accom�lisriments Or O�ner Qua1i,`ications: <br />�K.0 S 1.1�.�r,%' . <br />� IZ.O✓� �/-� J./ YJ ��7 i2 k %�J .°./6�/'�% / �"/✓ <br />?'_�ase S�3ta '�our Reasons cor wanting ?'o Sar-�e On T�.is Commit��e: <br />�� i�)ZC��o�� %��1C��� �J� �l �w �9S A COf`'J�`1.JNiTy <br />% l-�%� 1' C� i`7 I Ala ,J f� J �.�! a�t �L� C� r� S: l��n,. j�o :� ��'°��J. i y� i✓ e v�- <br />r1..� �it� c%' T, o� 1�� �1 S ,� � � 4� �i� 6.E C�'' �S � � tJ l� ��J S �.r� ,�'�SS.� T�L <br />��Ni/: �, ►�.ca. <br />Ycur r=saonse to any o= the above may be con�inuec on tne bac.{ ���� <br />and you may at`ac : any ot:�e� materia? s:�hic:� you want t:�e Council <br />�o consider. ' <br />Signatur� <br />�a tz <br />T�e C i tv of ��toVnds liew is commi tted t� t:^.e �o1ic•� �:�at al? <br />pers�ns� s:�a11 have equal accsss to its orograms, L�c:1:.t�.es, <br />•3:riD1CV?il@Clt W1tI10U� Y2C�d�� t0 �3C°� C�@°Ll� C^.�OL'� S2:C� �uCje� <br />na�ional origin, or handicao. <br />_� �� <br />I� S�.�n i�'£ ,��►� sS� U� � ��IS <br />�%<'F',-.� <br />and <br />t <br />a s ,� �✓ ,�:X c � ��� <br />J� 1....1 V.t /4 r/!) v,.:�G �2./c, <br />-i <br />