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APPLICATION FOR ADVISORY GROUPS <br /> • <br /> Group Applied Far. <br /> Econorn;c, a ,e1) <br /> 2lO.pgvo- e_Dmfy.izan <br /> Second Choice (if any): <br /> ��6.tY1 Y1.1 Ylc� co YY1r`f1 j�s i ZSr1 <br /> Full Name (print or type): <br /> '_• : 2_t.aA YY1.Q.r-t <br /> Address: '-i : <br /> Years at This Address: Years You Have Lived in Mounds View: <br /> 71a <br /> 1/ <br /> Telephone: <br /> P Home: Work or Other: <br /> :► -S$77. lag .s <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests: S lfQ" <br /> Employment, Occupation or Other Experience: <br /> Memberships, Accomplishments or Other Qualifications: <br /> Please State your Reasons For Wanting To Serve On This Committee: <br /> • <br /> Your response to any of the above may be continued on the back andou <br /> attach any other materials which you want the Council to consider. y may <br /> Signature\_ A 4..4, 1/1/1.0, <br /> Date `�/,C-�lC ' <br /> 4 <br /> The City of Mounds Viewcommitted <br /> ro to the police that all persons shall have equal <br /> access to its <br /> programs, facilities, and employment without regard to race, creed, rotor, <br /> sex, age, national origin, or handier. <br />