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APPLICATION FOR ADVISORY GROUPS _ <br /> Group Applied_Eor:. <br /> (' rk ( c slz �orce_1 Icor\orvL c ()eve(ep4, a,. A i ori <br /> Second Choi ( i` any) : 0 <br /> Full Name (pr nc o type) : <br /> e�eTC� <br /> Address:,-- <br /> / // <br /> ddress : /Z// /1 S.S/o/ <br /> Years At <br /> This Address : Years You Have/ Lived In Mounds View: . <br /> / - <br /> Telephone: Home: Work or Other: <br /> co 2,3 7K y- /s A 3sy <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests : <br /> A/Lar12,2 <br /> Employment, Occupation or Other Experience: <br /> C rr n�rI crS ar1Qe (,� e,-a- rK.,- �/ c=6,-c=6,-'--/,/e -, � <br /> • ?c- r te f---or -e"fryj <br /> rnn Scs � �, e s6.1,./ .4S e 66) 0 s <br /> Membershipsccomplishments Or Other Qualifications : <br /> fly Irl N1 ;nnes m��,cm !'uar z ASSoc <br /> N ,.hof Ana e; ��- sE, � m K Acarippw ASS' <br /> / S �s c 'e pe �ti u // <br /> Please State Your Reasons For Wanting To Serve On This Committee : <br /> S S cr" a, ;-A- v- pfr' 'fey <br /> _. <br /> PhS elf to <br /> Mr - ,ro c Tort--. <br /> Your resp•{. se to 6Any 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 l Date 9-a/- 9 / <br /> The City of Mous 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 />