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• <br /> APPLICATION FOR ADVISORY GROUPS _ <br /> Group Applied For: --2127 _ <br /> 4 <br /> Second Choice ( if a y) : & , , <br /> 3 N c - <br /> Full dame (print or type) : <br /> Al) 'r 416 4 • iiryhci <br /> rdress `` <br /> ay , nk.-ifc�- 1.�i'S /44cxiLS V &3 �rr Ci- 2 �. 7 ai/ ' ; - - <br /> Years At This Address . Years You Haire Lived In Mounds View: <br /> Telephone: Home: Worst or . Qther: <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests : /z'Y '5 , L4WC <br /> / ,-(J/),'2 /47Le-4 _,cr'd /71 kivzi/m /e emnak Me o ,) A <br /> Employment, Occupation dr O,tner Eience: C 'Y/4/ <br /> eala.Y7Ii3 D'i ovy rock) v_piefiovisc:), / 14,4( rri-lj <br /> ' ' )- GGA' ./ C p)/ 2/ ip .64___: <br /> 7) -te.-At___,(embe- nip , Accomplishments Or Other Qualifications : <br /> Please State Your Reasons For Wanting To Serve On This Committee : <br /> --JD ?ic oZtt-ct' 1,1kfra-3 ,i/eiq Lc/hi &?6� <br /> �!��,k 0 41 O(ic:/"ig--5 U/ eL <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 /> S igna fur, iW _,/ )/ _ Date SV/ :2 <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 , <br /> national origin, or handicap . <br />