Laserfiche WebLink
APPLICATION FOR ADVISORY GROUPS • <br /> OR COMMITTEES <br /> Name of Group or Committee Applying For: e0cue ,e CG <br /> Second Choice (If Any): <br /> Full Name (First, Middle, Last): � LAP-4c)eNI <br /> Address: 99 ( r7 <br /> Years At This Address: -33 Years You Have Lived In Mounds View: 33 <br /> Telephone Number Home: 28t./-7728 Work or Other: ...SW– 30 / <br /> QUALIFICATIONS YOU WANT THE CITY COUNCIL TO CONSIDER <br /> Skills and Interests: u fPcP4--cam' /`‘1o1‘lc2/ So t�zy . 4114.,e� <br /> • <br /> Employment, Occupation, or Other Experience: <br /> • <br /> Memberships,Accomplishments, or Other Qualifications: <br /> Please State Your Reasons For Wanting To Serve On This Committee: <br /> -=(vTC 2c;,—t-40 /110 v Dt\ c Lc e /U A- <br /> -HhScLL8L <br /> Your response to any of the above may be continued on the back, and you may attach any <br /> other materials which you want the City Council to consider. <br /> Signature Date -2-3 Ci <br /> The City of Mounds View is committed to the policy that all persons shall have equal access to its <br /> programs, facilities, and employment without regard to race, creed, color, sex, age, national • <br /> origin, or handicap. <br />