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• <br /> APPLICATION FOR ADVISOR`_' GROUPS <br /> Group Applied For: <br /> Second Choice ( i= any) \( -± <br /> -43 <br /> Full Name (print or type) :_., ) j� / <br /> (,�OZ 1 • 3'— 3 cz2vvtl�_ <br /> Address : ?J. <br /> Years At This Address : .. Years You Have Lived In Mounds View: . <br /> Telephone: Home: Work or Other: <br /> QUALIFICATIONS YOU WANT TO HALE THE COUNCIL CONSIDER <br /> Skills and Interests : 7 c- <br /> . Z, .Ztrk :cncc, 5;i ) arc t.�t o r.:c�14,y \Ta <br /> ) ein.J t:o v�w•.t:. ( t <br /> (A.A.; �tG�cy�t5.}.1 h—C5{r�:F(� tZi.v�K�CGtI wCi,l ;y (�� �v.�cc� r.1ti+�Gt ?kf.:-.,A <br /> Employment, Occupation or LLOther Experience : <br /> • t-4—""-q'"=4-4,.-7- ,S ` 5 t-sT�.1.GY .� FC , / ,� t '7),fi4134Se <br /> • <br /> S. `� CSt rac k2 I L o , <br /> GLUM„^� •- ,-4--63”.�s.oi-'%l <br /> Memberships , Accomplishments Or Other Qualifications : <br /> Please State Your Reasons For Wanting To Serve On This Committee: ' <br /> .Ti wo..,. si ��{"jc.G. � �'.c'-.-..,� �✓� :7•^.v p':-- ('-�nC`..` .;�.....K�TTgu� -gyp Gn•'-� rtli; <br /> ;CH", ,.L K ,v 1- t- ` o..c l'- 21 <br /> l�t✓L �o br,• . '.;±-ro..t :i%rv.\ I ptr-�yrt_V ,vP_•^�..ii ,��` icke <br /> � / 1 N , J / <br /> ,.p iVyk� (G42\ue , ��it.:.Cj t=c�L�t•� +� `:,'try iJ(— :`'!C�t,.l_�.: `. •/1... f.v .:"C`«�'. :�.c <br /> ,.C • .11 'C'r- Ll c' - e tG . +7.1,.,311G.i- { .+� :RNA :i/�C c I0 �J 5'5.'474.. <br /> `cur 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 fr,nrz Data L /4.,4' <br /> The City of Mounds View 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 , 41/1 <br /> national origin , or handicap. <br />