Laserfiche WebLink
City of Mounds View <br />2401 County Highway 10 <br />Mounds View, MN 55112 <br />763-717-4000 <br />Application for Advisory Commissions and Committees <br />Group(s) applied for: C l&PL-4 CewiMiSS%av,ghQ- N 5„ ASO , <br />Full Name (Please Print): 5}P—�l e -A �. 7 mS1 <br />� <br />Work Phone: I Worl Cell Phon • 65I a1- -7-- 1So2`1 . <br />Address: L.o,tia. L I,.¢. N(n,w,14gmmt.1 sstiz <br />0 <br />Years at this address: t.6 Years you have lived in Mounds View: i S" <br />E-mail Address: aorto <br />Experience and Qualifications <br />Skills and Interests: <br />Employment, Occupation or Other Relevant Experience: <br />GivTjl(;n,1i1w�A.wAK�� �w�iheet— <br />Memberships, Accomplishments or Other Qualifications: I <br />MN 6-'!' 41 <br />eF Pro lx sS, wl EL �SusdS. 'J cr K�Golt ort eo,M v,iYex <br />AyAex,IA ✓. �ci• a� Givi( �i��+P.t�i� <br />Please state your reason for wanting to serve with this group: n <br />Z. WOU-4 }'6- a-0 4elj' µomv�.1S Vi Co.S -AAA ,tail,.y 6a�ahCC a"s <br />rta�ure w.d dua(nPr+*Kf as +ael( a5 fniro�}ace Ser.K Aew iden5 di mar <br />be (re�ne�riai� <br />Signature: Date:. id 1711t( <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 />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, ethniclty, sex, age or physlcal abilities. <br />