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APPUCAT1ON FOR ADVISORY GROUPS <br /> r — <br /> . Group Applied For: ____.... • <br /> Second Choice f <br /> Full Name (print or e): <br /> Address: <br /> — cP S /l/..�' l /D / v Q//ll <br /> I <br /> Years at This Address: Years You Have Lived in Mounds View: <br /> /`7 <br /> Telephone: Home: Work or Other; <br /> 7� '77/7 <br /> ...S� <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests: -- — <br /> ®T' ldrq.r A T/'/�1 �� G CO�D.�4/.G "4 ,/. ;:n1 f- <br /> ��� � 770,.... Qt I • <br /> Employment, Occupation or Other Experience: <br /> Memberships, Accomplishments or Other Qualifications: <br /> /''1j...err <br /> /std.- !/.' �if/G... /�ti ,f}... ��� [ <br /> ,Ifr <br /> P�lea'sepState your/Reasons For Wanting To Serve On This Committee: <br /> I Your response to <br /> any of the above may be continued on the back and you may <br /> I ash any other materials which you want the Council to consider. ' <br /> Signature�_, �A d_-&--- <br /> ,L....=___ Date 3/A <br /> The City of Mounds View is comm* th //e police that all persons shall have equal <br /> is <br /> access to its programs, facilities, and employment without re <br /> secage, national origin, or handicap. Bard to race, creed, color, <br />