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APPLICATION FOR ADVISORY GROUPS <br />Group Applied For: <br />Second Choice (if <br />any): <br />Full Name (print <br />or type): <br />�.P,rt <br />(� Lcnrl <br />Address: O rx '�ed <br />i" <br />Years At This Addss: <br />Years <br />You 'HavIIe,,jived In Mounds View: <br />§ 91Telephone: <br />Home:Work <br />gab -55-W <br />or <br />9 Sy -(4m er <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />Skills and Interests: <br />om Vorc ac+iV-e, a.+ Rnewood rlemn-fk� <br />wp/Kin Widal readln� Giroa ,'arns 4AJ?4ti CLa rade/&0dVj coot4i <br />r P n /!C!• <br />Emplo, entU, O c pati n or Other Experience <br />Wofkea c'+ CAy Iq wz -� +'-;, 0w4 CA <br />CLr,6 Wof-y-� t&V �bein A V(, amrner''s <br />i newc�o 1� m e n`E r� CA -S CI <br />r <br />Membe shi Accomplishments Or Other Qualifications: <br />,45515`±' wi)t& Brownie,Irovps� assj"3 - LA,1 % eAurc� <br />�u�lG. roves member P;' e ' c)d, /QTR, <br />67-0u� o �,'reaf <br />Boa Ks inV�a-� Pintfwood, ac4iuep ,n. voGvn4er t,�ark <br />2lneLk)Q6 j <br />Please State Your Reasons For Wanting To Serve On This Committee: <br />L eek - ha� (/ve A5 (a Commur,i9��c.{ ( have a <br />res On Si bile nv- de urs I irSs�Yucd�°ova(?' <br />and So Ice G w <br />Your response to any of the above may be continued on the back <br />and you may attach any other materials which you want the Council <br />to consider. <br />Signature j1jC(/yvVt/. Date f X4q&_ <br />The City of Mounds iew is committed to the policy that all <br />persons shall have equal access to its programs, facilities, and <br />employment without regard to race, creed, color, sex, age, <br />national origin, or handicap. <br />?etck) <br />