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APPLICATION FOR ADVISORY GROUPS <br /> Group Applied For: , <br /> 2 Tr-e c:4P'm J <br /> Second Choice (if any): <br /> • <br /> Full Name (print or type): <br /> ri \44. ,L(,d--e4/ <br /> Address: 7 7 <br /> 7S '5, ;,,�.,S�L <br /> Years at This <br /> Address: Years You Have Lived in Mounds View: <br /> Telephone: Home: Work or Other: <br /> 6 LI <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests: <br /> Employment, Occupatiorr or Other Experience: <br /> Al h i'vet <br /> 111‘,9,,Yi 5 6e9. AI,/5/ <br /> Memberships, Accomplishments or Other Qualifications: <br /> Please State your Reasons For Wanting To Serve On This Committee: <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 /> Signature .���� ,/ i/ r Date —5--- <br /> l� 152 <br /> The City of Mounds View is committed to the 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 />