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APPLICATION FOR ADVISORY GROUPS <br /> • <br /> Group Applied For: • <br /> ccor1Cm 1 c, aeve1O.} mate-- e_ommi 6/1 <br /> Second Choirs Cf any): <br /> �l�tnn.,,(1.c, cDmrn;�51 On <br /> Full Name (print or type): <br /> .. R_• : )►_.4A Marl-jr- <br /> Address: <br /> Years at This Address: Years Ycu Have Lived in Mounds View: <br /> 71a <br /> Telephone: Hoare: 11 - <br /> Warlc or Other: <br /> IP --ig7‘v 7aq S <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests: S C2�-�Q.c.1�O� <br /> 410 <br /> Employment, Oca.ipaticrr or Other Exerienca: <br /> Memberships, Accomplishments cr Cther Cuaiincons: <br /> I <br /> I <br /> Please State your Reasons For Wanting Ta Serve On This Committee: <br /> I <br /> • <br /> Your response to any of the above may be continued on the <br /> backIattach any other materials which you want the Council to considerand you may - <br /> . <br /> 0 <br /> Sigrtal: <br /> re\ ,t n al a .t --4//'/I.Cl7- l v <br /> oate�,a./� <br /> t v , C.- ` <br /> The City of Mounds View is crmmitted -c <br /> access to iirs �e pciic.. �� all persons shall have equal <br /> Programs, facilities, and employment without regard to race, creed, =la, <br /> sex, age, national origin, or handier. <br />