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APPLICATION FOR ADVISORY GROUPS <br />Group Applied <br />For: <br />Second Choice <br />(if any): <br />Full Name (print rtype): <br />Address: C7 <br />J <br />Years At This <br />Address: Years You Have Lived in Mounds View: _ <br />4 <br />Telephone: Home: Work or Other: <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />S js and nterests:. <br />Emoloym t, Occuca/t�ion or Other Experience: <br />te..s'/ <br />T c <br />- <br />Me ersh.L s, Accomplishments Or the_r Qua IIficat' ns: ! <br />2 ' <br />A, V -e; 11 11U11— c!�X *1'd ell)ea <br />jvL 6 <br />2lea%s^e^�St�tate Your Reasons For Ranting To Se/ ve On This ommittee: <br />iY-�i(.Cl✓Y'`� (�O �/ ) (/�tii°`Q � (') (/ -*�'L� /,�, <br />Your r- ponse o any df the ab ve may be continued on the <br />and yo may attach any other materials which you want the <br />to consider. <br />back <br />Council <br />Signature ,tea, V ��o� Date <br />The City of Mounds View is committed to the policy that a'_1 <br />persons shall have ecual access to its programs, facilities, and <br />employment without regard to race, creed, colori sex, age, <br />naticnal origin, or handicap. <br />fl�e_j <br />7 <br />