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APPLICATION FOR ADVISORY GROUPS <br /> Group Applied For: <br /> Second Choice (if any): / 1 <br /> iJu:vc 7 ..� <br /> Full Name (print ore): <br /> (-7 CC y / ,✓ <br /> Address: <br /> Years at This Address: Years You Have Lived in Mounds View: <br /> Telephone: Home: -7,e, -7717 <br /> Work or Other. <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests; <br /> ,e:cs,� <br /> Employment, Occupation or Other Experience: <br /> c./e ,",y,0/y. <br /> /'+�wt/i"= �'-jam- <br /> Memberships, Accomplishments or Other Qualifications: <br /> `''7✓N*9� - /I'Zd 4-wi <br /> — J^' '' v -� �L <br /> Please State your Reasons For Wanting To Serve On This Committee: <br /> e� ,- /4 G � ��, �- ..,.� (/��.✓ <br /> Your response to any of the above may be continued on the back and you may <br /> attach any other materials which you want the Council to consider. <br /> S gnature 4�rfi.1,• G U – A.__ — Date // <br /> NW The City of Mounds View comm' - Irthe police that all persons shall have equal <br /> access to its programs, facilities, and employment without regard to race, creed, color, <br /> sex, age, national origin, or handicap. <br />