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APPLICATION FOR ADVISORY GROUPS <br /> Group Applied For. <br /> • <br /> Second Choice (if any): <br /> Full Name <br /> (print or)pe): <br /> re 097 //�,✓ r%afr.�s <br /> Address: <br /> ‘228lo <br /> Years at This Address: Years You Have Lived in Mounds View; <br /> /7 <br /> Telephone: Home: Work or Other <br /> �� -777 <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and interests; /�' <br /> 1t/iek/ Tit /46/ <br /> do <br /> �.�. G�`c T,e �tL � • <br /> Employment, Occupation or Other <br /> Experience: <br /> ��G✓/''�!` <br /> .4- <br /> ,o. -4r- /— t--4!' ‘4't i4_1 <br /> Memberships, Accomplishments cr Other Qualifications: <br /> Com...,... ,� -- �,.i ', v �L #44'4"r !! <br /> Please State your Reasons For Warning To Serve On This Committee: <br /> fir; /4. ve... <br /> Your response to any of the above may be continued on the back and you may <br /> I <br /> attach any other materials white you want the Council to consider. <br /> Signature <br /> Date '5". //// <br /> The City of Mounds View is comm' the police that all persons shall have equal <br /> access to its programs, facilities, and employment without regard to race, creed, color, <br /> sec age, national origin, or handicap. <br />