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4111 <br /> APPLICATION FOR ADVISORY GROUPS _ <br /> Group Applied For: • <br /> IPLRtari 11,16 COmtnrS5ici4 <br /> Second Choice ( if any) : <br /> Full Name (print or type) : r) <br /> KJChRR4 0, OmpN <br /> Address : <br /> Sao RoV61- wc) Po R8 <br /> Years 'At This Address : Years You Have Lived In Mounds View: <br /> 3. � <br /> Telephone: Home: Work or Other: <br /> •786-667 <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests : <br /> I}m 6.X1,6RIFNCed /N T1,E pROffsS Of PCtr/n/55/o/v <br /> IhTIES, dqN zwe Ui0// u.;Tn om,,e5, ev' EXE,M5C4 500441 ju456mCN77 htlt'r' <br /> 3N C"fN rnAvd r LIS/f /d porfl;407-6: TL' c e)/y', <br /> Employment, Occupation or Other Experience: <br /> 3 / yES. /N (10 A'i RUCT70 N Fie/c// iY y,5. /?E/rxc'e 1✓TRt r ORS 45e , "p . 41) <br /> 12Rgeri ge 5 o A eominwC;AL Res/ciFNr/) T O,) 4.)c`t/EC a7mc`,vi3. r/9177/1/RA /a//7% A1/ <br /> i)1,, s a/ ?Rape s FRem ,O/R%,VINS PeR;n)75 TO ,JUivcl,I)573 v !'arnp%f:ia;v. <br /> 31p L,TI fry TO v NdERs779,1vaf D Li:t`pR;NTT •. CO/1,7"P T DoeN77 , e-re: <br /> Memberships , Accomplishments Or Other Qualifications : <br /> 19 A De RFE - /72INNFf7Pe1;5 470mmd,y/11/ (Pe l/FSE /170di✓o'.5Gh w' ('6p87-64, earn/71/55i , <br /> /)lf/nhefi/ AgPXl dF mo6•,v1s i%i61,✓ cNv%�aA4r,eA rHL • e;/‘j 00 n.„ av <br /> Please State Your Reasons For Wanting To Serve On This Committee: <br /> (,(9.r /9hL '; &'' T y •9 PitT3 i< -/-1.1g6- /9"107 i he//<W 1-AAT my <br /> a•/,/%5" AV d 6- it-V•e)e ff v ;/ ( hi/1;/ 1.-A F 5 <br /> �G min,S <br /> Your response to any of the above may be continued on tne back• <br /> - and you may attach any other materials which you want the Council <br /> to consider. <br /> Signature - %/,. ,.✓ ,(// K Date L/ <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, 4111national origin , or handicap. <br />