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c <br /> APPLICATION FOR ADVISORY GROUPS <br /> OR COMMITTEES <br /> Name of Group or Committee Applying For: Ayps 6, elf- re j ,1 ( ,,, <br /> Second Choice (If Any): <br /> Full Name (First, Middle, Last): /7'2 6,--y /77._ (3.e,i Z, <br /> Address: 0335 ,t .0., e <br /> Years At This Address: 7t; Years ou Have Lived In Mounds View: /0 <br /> Telephone Number Home: 7,91_/oc, Work or Other: 6 )l - 3 75 / <br /> QUALIFICATIONS YOU WANT THE CITY COUNCIL TO CONSIDER <br /> Skills and Interests: 5 cv /3 0,-i di eh; <br /> Employment, Occupation, or Other Experience: pit_ <br /> Memberships, Accomplishments, or Other Qualifications: ^.^.`"3 <br /> 0/ PiC c9 i 74, m /l7 /f o i t/x'.5 (1 t'Lv r r- 6291- /F <br /> Please State Your Reasons For Wanting To Serve On This Committee: ,L.. - i;.,l!_ <br /> IT (.0l)/e %l C L� 2_ JAG?sem //).�j'/;5- <br /> Q 1/..P_�y Cc o_P.q;_e_. P.,e v , <br /> Your response to any of the above may be continued on the back, and you may attach any <br /> other materials which you want the City Council to consider. <br /> Signature /- Date ///�o / cS <br /> The City of Mounds View is committed to the policy that all persons shall have equal access to its <br /> programs, facilities, and employment without regard to race, creed, color, sex, age, national <br /> origin, or handicap. <br />