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Microsoft Word -Advisory Commission Application.doc - Boards_... 11ttp://A,\VW.Ci.mounds-view.nut.tishIellicl[/sites/f 9DACB450-96B3... <br />City of Mounds View <br />2401 County Highway 10 <br />MOUnds View, MN 55112 <br />763-717-4000 <br />L <br />�preldz a ic�ij scju: gvis -Aj grIlMissi ass-atnd �:c�r��¢�nifie , <br />Group(s) applied for: <br />Full Name (Please Print): l ti (_ ig rt 1u �. r,iY <br />Work Phone_ Work/Cell Phone: <br />Address,- <br />Years <br />ddress: <br />Years at this address: ___� Years your have lived in Mounds View: <br />E-mail Address: � l;k _q r_u i- 1"11, (11 <br />Gxperi nee <br />and Qualifications <br />SI(ills and Interests <br />! i 1 <br />lllrc�iri rte IL\ its nv+�it �dt[� SIS°,i r�iiir. ��rll�r� 1`;S�C -I rnei {1�n�o�, �J1f�lUr�ifl�Jp� <br />(��u117�i011U� ��)bl,r i(iiiV -, !Clivi iilU.lb G%�-�.)i [11,I �i ��(.l�ll l��r G�'tCU-iiVli ����tr llJf�Gti�b�, <br />) <br />IILt�n i�[:. i' lr}GJ1-f1 <br />Employment, Occupation or Other Relevant Experience: <br />i <br />>'I) 1,'Xula r Ir('�11 <br />Memberships Accomplishments or Other Qualifications: <br />,tn. Ul'PVVPxii���(� (�t�rut.it1l l <br />rlir ira/�ii,lhin��µ ��)r'i-i•ucth-i �iibt <br />yIL� (hGl'11�11i( Titter ri.`/i�iIlV1C�71a�1�) 9 i�ri 4!Ic,�iL� (IIfUf or Ill' (I`�t�i�.� hCt��(:il'�t17}� <br />(�(Ar(t°ti i�, iioSi it Ali, I�U`(n C. Z.I GhCj 4J: <br />Please state your reason for wanting to serve with this group' l <br />LleII„ I(( -a�:< p ..1 �.=nr,� dl<., ic-�ca)t imc C� r11f vrl,5� -�0,/ tut <br />Sigm title <br />r <br />(YaUI rosponse t any of the above inquiries inay be continued on it,(, bacl< of this forms JICI You <br />may attach other inform:aiion that you would like the City (-,,ocmcil to cumsider.) <br />The City of Moands View is convnlHed to the policy that all porsons shall have access to its progr'arns, <br />facilities and employmenf Wirhoul regard for race, eihnicity, sox, aye or physical abilities. <br />4/19/2013 10:39 AM <br />IofI <br />