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<br />Grouo r�ppiied For:
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<br />Second Choice (i� any):
<br />.� t � r tFj: _ � , �r� .. !: -;,,f�,.` : �: r -� ° .,� ..' _ - -- . - .
<br />Full vame (princ � type): , ` -
<br />��-°d. � -�,r%� .�t/ � /% /���°��° SS �
<br />Address:
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<br />Years At�his Ad I
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<br />Talephone: E� -
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<br />APPLIC�TIaN FOR ADVISOR� G�OUPS :
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<br />drzss:
<br />I�'',v� �,�i�E' .�'':''JGt /J �S�/� 2
<br />Years You Have Lived
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<br />Mounds View: _
<br />Worlc or Other s
<br />QUALIPIC3TION5 YOU WANT TO HAVE THE COUNCIL CONStDER
<br />S�c i 11 s a crd I n�. e r� s t s: c��-.. , � g.�,,r- � �,/.,, �.,��
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<br />Emoloyment, Occuoation or Other Ex�erience:
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<br />��'?@:ttD2�S.71�S, aCCCRIDlis:uaents Or Otl1EZ7 �ualii1C3�10(1S:
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<br />?�°i3S2 Stata '�our �2easons cor Svant�ng To Sa�ve On T�:�7�is Comm
<br />�i /'-%� "� ��' �l'i~.'',�r- � '`�-I �1.%%tf-"'f'%�/ �fr:�� � ; "��...-'�l/ �Lr�-.._
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<br />- ' -. j ��1../� ' � .-•- .. , �y'/�.._ f .. ,t � r ���/�y/ Gr/ 4
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<br />Ydu� �as�onse `o any oL �he above may be continueci on tRe oac:t
<br />and vqu may attac;� any ot:�e� :natarials :�hich _rou want �he Ceuncil
<br />`o cons=�er.
<br />S igna `ur� � � �/''° Q�
<br />' � �i''�-� � Da ta G '�;�- ,
<br />T�e Cit_r o� Mounds View is committed to trie policy �hat ali
<br />persons s::a11 nave equal access to its oro�rams, racilities, anc
<br />amoloyment witnou� �egard to race, cr�ed, c�1or, ses, a5e,
<br />�zat�onal orzCin, or handicap.
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