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APPLICATION FOR ADVISORY GROUPS <br /> • <br /> OR COMMITTEES <br /> Name of Group or Committee Applying For: 5 <br /> Second Choice (If Any): <br /> Full Name (First, Middle, Last): <br /> Address: 99 ( r] �o J 1 <br /> Years At This Address: 73 Years You Have Lived In Mounds View: 33 <br /> Telephone Number Home: ?gtf-7728 Work or Other: /— 30 / <br /> • <br /> QUALIFICATIONS YOU WANT THE CITY COUNCIL TO CONSIDER <br /> Skills yand Interests: v �coP� C41,7,,,,47"/C2/lc—y S ?'d7 /Ll4 <br /> . 561/,/� <br /> . <br /> • <br /> Employment, Occupation, or Other Experience: <br /> `fir( v RL--st,--ri rt J e- <br /> Memberships,Accomplishments, or Other Qualifications: <br /> Please State Your Reasons For Wanting To Serve On This Committee: <br /> Z'vTc21�;,7 I,u /Ltov 05 U r cc-i e c..o P 1 '(T / A. / <br /> I— Q= LL CS'S ‘11 LE <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 v / l Date 72/9/) <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 />