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Medtronic <br />City of Mounds View <br />2401 County Highway 10 <br />Mounds View, MN 55112 <br />763-717-4000 <br />03:47:31 p.m. 11-20-2015 ill <br />Application for Advisory Commissions and Committees <br />Group(s) applied for: Pja�11V1 n1 C�i�tYhIS51o{rI , P�r1cs recrFattoi? P' / D��'j <br />Full Name (Please Print): w0\5On micho el Frp11 C� <br />Work Phone: 76 3 — 505 — 5-75 o\ <br />Address: a q 7 4 Couni uJ <br />Years at this address: Years you have lived in Mounds View: <br />E-mail Address: JaS�11=M,Fren�h O Gyhail , CD11'I <br />Work/Cell Phone: <br />U <br />763 -63q -6M3' <br />Experience and Qualifications <br />Skills and Interests: <br />Cons%vCttonlSnowboar'Ji �yt {���yl�j Vitt, �hild��vr <br />Employment, Occupation or Other Relevant Experience: <br />Murry c -F)r fin lasf 11 Pry, W kit or- fh� <br />Colt/mbl�t lfPpy f" 0, ears in Pt btic t,��rICSF <br />Memberships, Accomplishments or Other Qualifications: <br />Please state your reason for wanting to serve withis group: <br />T q(�V v� in /'&/'Z�s (t"G./ �tv�c� eve POO wvrj bAc L/I vii <br />ly✓ <br />Walk <br />d�j �ccr1 t9 KP�� �'ti city Jr`¢. <br />Signature: Date: <br />(Your response to any of the above inquiries may be continued on the back of this form and you <br />may attach other information that you would like the City Council to consider.) <br />i - <br />The City of Mounds View is committed to the policy that all persons shall have access to its programs, <br />facilities and employment without regard for race, ethnicity, sex, age or physical abilities. <br />Received Time Nov. 20, 2015 3:48PM No. 2589 <br />